DI Benefits Medical Cons

Northwestern Mutual; Wisconsin; Hybrid; USD 89,000 - 134,000; Full time

Job summary

Northwestern Mutual is seeking a Medical Consultant to provide technical medical expertise within the Benefits Division in Wisconsin. The role involves reviewing disability claims, evaluating provider records and treatments, and delivering clear assessments and recommendations to medical directors and analysts.

The position includes coordinating referrals with physicians, educating new analysts, and leading cross‑department projects to enhance claim protocols.

Qualifications

• Bachelor's degree in Nursing with professional nursing experience.
• Experience as physician assistant or nurse practitioner with related degree.
• Strong decision-making and ability to work independently.

Responsibilities

• Provide medical expertise and reviews of claims, evaluating records and treatments.
• Consult with analysts, medical directors and outside physicians; communicate assessments and recommendations.
• Coordinate referrals with medical directors and external consultants; lead or participate in projects to improve protocols.

Skills

Medical Acumen

Medical Case Consultation

Decision Making

Claims Acumen

Dispute Resolution

Coaching & Mentoring

Adaptive Communication

Education

Bachelor's degree in Nursing

Bachelor/Master's degree (PA/NP)

Job description

Primary Duties and Responsibilities

Provide technical medical expertise and support to the Benefit Claims analysts through thorough review of claims to include evaluation and analysis of provider medical records, test results and course of treatment. Provide timely consultations with the analysts and identify when additional medical information is needed. Clearly communicate the disability claim assessment, rationale and recommendation with medical directors, outside consulting physicians and analysts regarding insured’s medical condition, clinical medical findings, significance of and support for claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work. Through triaging of disability claim referrals, identify the need for and coordinate the handling of claim referrals with medical directors and outside consulting physicians. Acts as a liaison for the division with all medical resources to ensure that medical reviews are thorough and complete and adhere to the claim philosophy of the Benefits Division. Effective medical education and training for new disability benefits analysts. Prepare periodic presentations to the division to help ensure efficiency and consistency in administering medical claim protocols and processes. Participate and at times lead inter and intra departmental projects and committees Train new DI Benefit Medical Consultants when required and participate in peer auditing Occasionally partner with law department to help resolve claim medical disputes via negotiation and/or participation in litigation.

Qualifications

• A minimum of 5-8 years of professional experience preferably in critical care nursing, medical-surgical nursing or orthopedic nursing with a bachelor’s degree in nursing
• A minimum of 5-8 years of professional experience as a physician’s assistant or nurse practitioner and associated bachelor/master’s degree
• Consistent critical decision-making skills and flexibility in all aspects of work
• 2-3 years of successful complex claims assessment, rationale and recommendations and communication with physicians, analysts, lead consultants and teaching at the medical consultant level
• Ability to consistently assess claims independently with consistent high quality audit results in all categories
• Strong interest in self-development with demonstrated leadership, engagement, and ability to work independently as well as with a team
• Excellent interpersonal skills and proven ability to work effectively with others at all experience levels
• Superior written and verbal communication skills.
• Flexibility and willingness to change as job duties change
• Knowledge of computer functions and experience in a “Windows” environment.
• Experience in orthopedic medicine or physical medicine and rehabilitation
• Knowledge of disability insurance or prior experience in insurance claim management.
• Demonstrated leadership ability.

Skills You Have

• Medical Acumen (Expert): Applies knowledge of medical terminology, anatomy, and medical conditions, as well as an understanding of medical treatment options and limitations, to review and analyze medical/claim records.
• Medical Case Consultation (Expert): Applies medical knowledge and clinical experience to provide consultation about a patient's medical condition in relation to benefits and underwriting.
• Decision Making (Expert): Makes timely, data-driven decisions by understanding the probability of success, identifying risks, gathering business requirements, and developing value statements.
• Claims Acumen (Advanced): Applies the knowledge of claims philosophy, contracts, and policies and procedures for filing claims, assessing claims for accuracy and completeness, verifying eligibility, and adjudicating claims based on established criteria to handle complex, contestable, sensitive, and large benefit amount claims. Evaluates medical, financial, and occupational information and reviews to determine if insured meets contractual provisions while taking the state regulations or other relevant contractual information into consideration to make informed decisions.
• Dispute Resolution (Advanced): Resolves conflicts or disagreements between parties. Identifies the issues at hand, understands the perspectives of all parties involved, and uses effective communication and negotiation skills to find a mutually acceptable solution.
• Coaching & Mentoring (Advanced): Develops others by providing actionable, constructive feedback through the lens of technical expertise and offers guidance to others on how to leverage, prioritize, and develop skills to achieve one's goals and objectives.
• Adaptive Communication (Advanced): Formulates strategies to be used to convey complex information about services, products, systems, or processes to targeted audiences; communicates and liaises between technical and non-technical audiences.

Compensation Range

• Pay Range - Start: $89,360.00
• Pay Range - End: $134,040.00
• Geographic Specific Pay Structure: Structure 110: $98,320.00 USD - $147,480.00 USD
• Structure 115: $102,800.00 USD - $154,200.00 USD

We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable.

Northwestern Mutual is an equal opportunity employer that welcomes talented individuals of all backgrounds.

We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.

At Northwestern Mutual, we believe relationships are built on trust. That our lives and our work matter.

These beliefs launched our company over 160 years ago. Today, they’re just a few of the reasons why people choose to build careers at Northwestern Mutual.

What started in Milwaukee, WI has grown into 7,000+ home office professionals split across 3 campuses: New York City, Franklin and downtown Milwaukee (HQ) - each one bringing with it its own unique talent and culture.

In a company with such a long and storied history, this may be the most exciting and important time to be a part of Northwestern Mutual as we are growing our digital and tech capabilities and are always on the lookout for bright, tech-savvy candidates.

Northwestern Mutual is an equal opportunity employer that welcomes talented individuals of all backgrounds. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.