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Senior Supplier Medical Process Specialist

89564

We are currently seeking a Registered Nurse to join the Zurich Pharmacy Program.

 

The Zurich Pharmacy Program provides benefits and payments related to Workers Compensation claims in order to help mitigate total loss costs for our customers.  The U.S. healthcare spend is on the rise and Pharmacy costs are often a primary contributor to the overall claims cost.  The dedicated professionals on Zurich’s pharmacy program bring a wealth of knowledge, skills and experience from various medical disciplines to uphold and provide a rigorous bill review workflow that delivers on Zurich North America’s customer-led philosophy and Claims strategy.

 

As a Nurse on this team, you will serve as a team member and point of contact to our workers’ compensation pharmacy program vendor.   An immediate key initiative will be to partner on a cross- functional team to develop criteria and a process workflow for the appropriate review, determination of payment/liability related to prescribed medications as part of a workers’ compensation claim.

 

Primary Accountabilities include:

 

  • Respond and resolve complex medical management inquiries and issue escalations professionally and promptly  

  • Review processes, identify opportunities, and plan transactional, workflow or systems solutions as part of continuous improvement and training efforts

  • Plan and perform data and quality reviews related to vendor performance to identify, assess and take action to mitigate risks and ensure compliance to governance controls 

  • Manage supplier performance to facilitate alignment with service level agreements by reporting and analyzing operational results, and identifying trends and issues


Occasional travel may be needed.

 

This position can sit in the following Zurich Claims Offices: Atlanta, Parsippany, Schaumburg, Woodland Hills, Rancho Cordova, Dallas and Overland Park.  This position would be a hybrid of 3 days in the office and 2 remote days.

 

Basic Qualifications:

 

  • Associate’s Degree and 3 or more years of experience in the Nursing area
    AND

  • Licensed Registered Nurse (R.N.) in state of residence

  • 3 or more years of clinical experience

  • Experience with Microsoft Office

  • Experience leading operational initiatives and/or work streams

 

Preferred Qualifications:

 

  • Bachelor’s Degree in nursing and 3 more years of experience in the nursing area

  • Nursing experience in utilization review, case management, workers’ compensation or pharmacy services/programs

  • Knowledge of CPT, NDC, ICD-9/10 codes and medical terminology

  • Experience in a transactional, operational or customer service environment

  • Quality auditing experience

  • Knowledge of the insurance industry and regulatory environment

  • Experience collaborating across work groups and/or companies

 


As a condition of employment at Zurich, employees must adhere to our COVID-related health and safety protocols (https://www.zurichna.com/careers/faq), including, without limitation, a requirement that employees attest as to their vaccination status with a YES/NO, and upload proof of vaccination status, or negative COVID test results when allowable, to a third-party vendor. These are continuously re-evaluated and the requirements may change at any time.  
 
A future with Zurich. What can go right when you apply at Zurich?

 

Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please click here to learn more.
 
As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet 
 
Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. 
 
Location(s): AM - Schaumburg, AM - Atlanta, AM - Overland Park, AM - Parsippany, AM - Rancho Cordova, AM - Addison, AM - Woodland Hills
Remote Working: No
Schedule: Full Time
 
Linkedin Recruiter Tag: #LI-DG1 


Nearest Major Market: Chicago

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