Analyst, Claims-Pet
About the position The Analyst, Claims-Pet position at Nationwide Financial involves reviewing and processing pet medical claims, utilizing veterinary knowledge to ensure accurate claim adjudication. The role emphasizes delivering quality service to policyholders and requires effective communication and collaboration with various stakeholders. This fully remote position offers flexible working hours after an initial training period. Responsibilities • Processes all new and pending medical claims according to the appropriate workflow. • Reviews veterinary diagnosis and codes claims according to policy provisions. • Ensures completion of claims by coding and processing or sending claims to appropriate workflow. • Determines coverage and approves benefits and eligibility of each claim based on the terms and conditions of the policy. • Accurately processes claims based on established criteria, provider contract plan and employer group provisions. • Requests, reviews and evaluates requested medical records or treatment notes for determination of resolving claims. • Ensures proper documentation in compliance with company policies and practices. • Records the final disposition of claims, including denial and/or issuing payment. • Identifies and advises management of questionable claims and questionable risks. • May perform other responsibilities as assigned. Requirements • High school diploma or equivalent; undergraduate degree in biology, zoology or related animal science field preferred. • State licensing and/or other certification as required; associates must acquire required Federal and/or state licenses/registrations within designated time period. • Three to five years of veterinary claims experience or equivalent training in a veterinary clinic/hospital position under direct supervision of a veterinarian/veterinary technician preferred. • Proven understanding of veterinary medical practices and treatment. • Ability to understand and use Nationwide Insurance policies, riders and endorsements and recognize and resolve questionable coverage situations. • Ability to read, analyze, and interpret documents. • Ability to solve practical problems and meet internal customer needs. Nice-to-haves • Experience in a veterinary clinic or hospital setting. • Strong written and verbal communication skills for contact with policyholders, claimants, physicians, medical staff, etc. Benefits • Medical, dental, and vision insurance • Life insurance • Short and long-term disability coverage • Paid time off (minimum of 18 days per year) • Nine paid holidays • Lifetime paid time off (8 hours) • Unity Day paid time off (8 hours) • 401(k) with company match • Company-paid pension plan • Business casual attire Apply tot his job