Senior Disability Benefits Medical Consultant - Flexible

Jobtome; Franklin (TN); On-site; USD 89,000 - 134,000; Full time

Benefits offered by this job

Flexible work schedules

Concierge service

Comprehensive benefits

Employee resource groups

Job summary

Northwestern Mutual is seeking a senior medical consultant to provide technical medical expertise for Benefit Claims analysts, reviewing provider records and test results to guide claim outcomes. You will communicate assessments with medical directors, coordinate referrals, and lead training for analysts to ensure consistent medical protocols.

The role requires leadership, collaboration with physicians, and the ability to manage complex claims, including dispute resolution with the law

Qualifications

• 5-8 years in critical care, medical-surgical, or orthopedic nursing with a BSN
• 5-8 years as a physician assistant or nurse practitioner with BS/MS
• Strong leadership and independent work capability
• Experience in complex claims assessment and communication with physicians/analysts
• Ability to audit claims with high quality results across categories
• Proven coaching and mentoring skills

Responsibilities

• Provide medical expertise and review claims with evaluation of records and results
• Communicate assessments, rationale, and recommendations to medical directors and analysts
• Coordinate claim referrals with medical directors and outside physicians
• Deliver medical education and training for analysts
• Lead/interact in departmental projects and committees
• Train new DI Benefit Medical Consultants and participate in peer auditing
• Assist in dispute resolution with the law department when needed

Skills

Medical Acumen

Medical Case Consultation

Decision Making

Claims Acumen

Dispute Resolution

Coaching & Mentoring

Adaptive Communication

Job description

Northwestern Mutual is seeking a senior medical consultant to provide technical medical expertise for Benefit Claims analysts, reviewing provider records and test results to guide claim outcomes. You will communicate assessments with medical directors, coordinate referrals, and lead training for analysts to ensure consistent medical protocols.

The role requires leadership, collaboration with physicians, and the ability to manage complex claims, including dispute resolution with the law