Claims Medical Management
Claims Medical Management
Description & Responsibilities
Responsible for the investigation, evaluation and disposition of medical cases on assignment, which may include an established portion of the office/team workload and/or individual assigned cases that present moderate to high exposure or complex coverage or liability issues, under limited supervision. Recognizes and develops countermeasures of problems of larger scope and complexity.
Responsibilities:
- Investigates claims to determine liability, medical necessity, causality. Reviews and verifies coverage and recommends ultimate resolution on assigned cases in excess of their authority to local claims manager and Home Office. Resolves claims within authority. Identifies potential suspicious claims or possible third party for subrogation.
- May be considered the office litigation coordinator and responsible for managing the practices and billing activities of outside and in-house counsel. Accountable for security of financial processing of claims, as well as security information contained in claims files.
- Ensures accurate reserves and settlement authority and adjusts as warranted. Recommends reserve increases on cases in excess of authority.
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
- Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports.
- May assist in the absence of the Claims Team Manager.
- Identifies and refers potentially fraudulent claims to the Special Investigation Unit.
- May represent the company on matters involving state or federal regulatory agencies.
- Recognizes continuous improvement opportunities and develops problem statements and countermeasures for implementation commensurate with the parameters of current assignment.
- May be involved in special projects at the direction of local management.
Job Specifications:
Reference: 2022-48347
Category: Claims
Primary Location: Uniondale, NY
Additional Locations:
Schedule: Full-Time
Category: Claims
Primary Location: Uniondale, NY
Additional Locations:
Schedule: Full-Time
Salary: USD $61,700.00/Yr.-USD $93,800.00/Yr.
Education Level:
Travel: As Needed
Education Level:
Travel: As Needed
Qualifications
- Advanced knowledge of coverage, medical, liability and complex claims handling procedures. Must be knowledgeable of state and federal laws in the jurisdiction in which incumbent operates.
- A full working knowledge of claims operations and procedures is required.
- Strong written and oral communication skills required as well as good interpersonal, analytical and negotiation skills.
- The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 5-7 years of directly related experience.
- Ability to obtain proper licensing as required.
- No-Fault experience is preferred
Featured Benefits
Here’s some of what you can look forward to as one of our employees.
Competitive CompensationOur compensation programs are designed to deliver above-market pay if you perform well, and significantly above that for exceptional performance over time. Virtually every employee is eligible for some type of variable incentive pay in addition to his or her base pay.
Flexible Work ArrangementsWe understand the role work-life balance plays in your ability to stay energized and engaged. So we place an emphasis on regular hours, flex scheduling, and generous time off through paid holidays, vacation days, and more.
Top-Notch Retirement PlansOur pension plan provides a monthly credit equal to 5% of your eligible compensation. You can also participate in our 401(k) plan, which offers a guaranteed match of $0.50 for every $1 you contribute, up to 8% of your eligible pay.
Career DevelopmentFrom regular coaching planning, to paid training, licensing, and 100% tuition reimbursement for approved courses, we’re dedicated to your continued growth, because we know it leads to continued success.
Health & WellnessYou’ll have access to comprehensive health, dental, and vision coverage, as well as a host of other insurance and wellness benefits—including progressive parental benefits and support.
Why Liberty Mutual?
At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That’s why we provide an environment focused on openness, inclusion, trust and respect. Here, you’ll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession.
Liberty Mutual has proudly been recognized as a “Great Place to Work” by Great Place to Work® US for the past several years. We were also selected as one of the “100 Best Places to Work in IT” on IDG’s Insider Pro and Computerworld’s 2020 list.
We have been named by Forbes as one of America’s Best Employers for Women and one of America’s Best Employers for New Graduates—as well as one of America’s Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: https://jobs.libertymutualgroup.com/diversity-inclusion.
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran’s status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Description & Responsibilities
Responsible for the investigation, evaluation and disposition of medical cases on assignment, which may include an established portion of the office/team workload and/or individual assigned cases that present moderate to high exposure or complex coverage or liability issues, under limited supervision. Recognizes and develops countermeasures of problems of larger scope and complexity.
Responsibilities:
- Investigates claims to determine liability, medical necessity, causality. Reviews and verifies coverage and recommends ultimate resolution on assigned cases in excess of their authority to local claims manager and Home Office. Resolves claims within authority. Identifies potential suspicious claims or possible third party for subrogation.
- May be considered the office litigation coordinator and responsible for managing the practices and billing activities of outside and in-house counsel. Accountable for security of financial processing of claims, as well as security information contained in claims files.
- Ensures accurate reserves and settlement authority and adjusts as warranted. Recommends reserve increases on cases in excess of authority.
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
- Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports.
- May assist in the absence of the Claims Team Manager.
- Identifies and refers potentially fraudulent claims to the Special Investigation Unit.
- May represent the company on matters involving state or federal regulatory agencies.
- Recognizes continuous improvement opportunities and develops problem statements and countermeasures for implementation commensurate with the parameters of current assignment.
- May be involved in special projects at the direction of local management.
Job Specifications:
Reference: 2022-48347
Category: Claims
Primary Location: Uniondale, NY
Additional Locations:
Schedule: Full-Time
Category: Claims
Primary Location: Uniondale, NY
Additional Locations:
Schedule: Full-Time
Salary: USD $61,700.00/Yr.-USD $93,800.00/Yr.
Education Level:
Travel: As Needed
Education Level:
Travel: As Needed
Qualifications
- Advanced knowledge of coverage, medical, liability and complex claims handling procedures. Must be knowledgeable of state and federal laws in the jurisdiction in which incumbent operates.
- A full working knowledge of claims operations and procedures is required.
- Strong written and oral communication skills required as well as good interpersonal, analytical and negotiation skills.
- The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 5-7 years of directly related experience.
- Ability to obtain proper licensing as required.
- No-Fault experience is preferred
Featured Benefits
Here’s some of what you can look forward to as one of our employees.
Competitive CompensationOur compensation programs are designed to deliver above-market pay if you perform well, and significantly above that for exceptional performance over time. Virtually every employee is eligible for some type of variable incentive pay in addition to his or her base pay.
Flexible Work ArrangementsWe understand the role work-life balance plays in your ability to stay energized and engaged. So we place an emphasis on regular hours, flex scheduling, and generous time off through paid holidays, vacation days, and more.
Top-Notch Retirement PlansOur pension plan provides a monthly credit equal to 5% of your eligible compensation. You can also participate in our 401(k) plan, which offers a guaranteed match of $0.50 for every $1 you contribute, up to 8% of your eligible pay.
Career DevelopmentFrom regular coaching planning, to paid training, licensing, and 100% tuition reimbursement for approved courses, we’re dedicated to your continued growth, because we know it leads to continued success.
Health & WellnessYou’ll have access to comprehensive health, dental, and vision coverage, as well as a host of other insurance and wellness benefits—including progressive parental benefits and support.
Why Liberty Mutual?
At Liberty Mutual, our purpose is to help people embrace today and confidently pursue tomorrow. That’s why we provide an environment focused on openness, inclusion, trust and respect. Here, you’ll discover our expansive range of roles, and a workplace where we aim to help turn your passion into a rewarding profession.Liberty Mutual has proudly been recognized as a “Great Place to Work” by Great Place to Work® US for the past several years. We were also selected as one of the “100 Best Places to Work in IT” on IDG’s Insider Pro and Computerworld’s 2020 list.
We have been named by Forbes as one of America’s Best Employers for Women and one of America’s Best Employers for New Graduates—as well as one of America’s Best Employers for Diversity. To learn more about our commitment to diversity and inclusion please visit: https://jobs.libertymutualgroup.com/diversity-inclusion.
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran’s status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices: Philadelphia | Los Angeles | San Francisco
From Our Employees
Katie G.
Product Owner
Katie describes Liberty Mutual’s role in using emerging technologies to anticipate and improve the lives of our customers.
Matthew M.
Scrum Master
Matt speaks to the fast-changing nature of technology and Liberty Mutual’s ability to foresee and adapt to changing technologies and customer needs.
Pranjal S.
Software Developer
Pranjal discusses the Tech Start Development Program and the role it played in preparing him for an IT-related career at Liberty Mutual.
Rebecca S.
Product Designer
Rebecca shares her experience participating in Digital Garage, a program in which teams spend a month away from day-to-day responsibilities to focus solely on a customer pain point and how to best solve for it.
From Our Employees
Claims
Liberty Mutual has provided consistent yearly virtual training through My Career and Development Center. Additionally, I have received training and insight into other parts of the business through the Individual Development Plan I set up with my manager.
Kyle J.
Claims Resolution Specialist III –Fastpath Property
Liberty Mutual has provided consistent yearly virtual training through My Career and Development Center. Additionally, I have received training and insight into other parts of the business through the Individual Development Plan I set up with my manager.
Kyle J.
Claims Resolution Specialist III –Fastpath Property
Liberty Mutual encourages one-on-one coaching with each employee and their manager. I receive weekly feedback regarding my professional development and I am able to discuss my long-term goals and how to achieve them.
Jenna M.
Inside Auto Claims Representative
Liberty Mutual encourages one-on-one coaching with each employee and their manager. I receive weekly feedback regarding my professional development and I am able to discuss my long-term goals and how to achieve them.
Jenna M.
Inside Auto Claims Representative
My favorite thing about my job is being able to assist customers and walk them through the claims process. I am able to provide them with the expectations of the process and what will happen next.
Tamia McK.
Claims Customer Care Associate
My favorite thing about my job is being able to assist customers and walk them through the claims process. I am able to provide them with the expectations of the process and what will happen next.
Tamia McK.
Claims Customer Care Associate
Liberty Mutual genuinely cares for and develops their employees. They also encourage employees to transition within the company and provide a great atmosphere for learning and developing.
Steven N.
Claims Customer Care Associate
Liberty Mutual genuinely cares for and develops their employees. They also encourage employees to transition within the company and provide a great atmosphere for learning and developing.
Steven N.
Claims Customer Care Associate
You feel part of a team. Everyone is appreciative of your hard work.
Gina D.
Senior Customer Claims Representative
You feel part of a team. Everyone is appreciative of your hard work.
Gina D.
Senior Customer Claims Representative
My goal in my position is to create peace of mind with the customer by listening to their specific needs and responding with concern and expertise. As I’ve continued to learn and grow in this position, I’ve expanded my claims knowledge,and providing that expertise to customers is very rewarding. And, I learn something new every day.
Alison W.
Claims Adjuster
My goal in my position is to create peace of mind with the customer by listening to their specific needs and responding with concern and expertise. As I’ve continued to learn and grow in this position, I’ve expanded my claims knowledge,and providing that expertise to customers is very rewarding. And, I learn something new every day.
Alison W.
Claims Adjuster
Liberty Mutual provides us with a great benefit package, excellent wages, an understanding of the need for work/life balance, and many career growth opportunities. We are also given additional incentives to achieve,such as the Circle of Excellence and the Chairman’s Award.
Jennifer A.
Claims Customer Care Rep
Liberty Mutual provides us with a great benefit package, excellent wages, an understanding of the need for work/life balance, and many career growth opportunities. We are also given additional incentives to achieve,such as the Circle of Excellence and the Chairman’s Award.
Jennifer A.
Claims Customer Care Rep
Liberty Mutual has provided consistent yearly virtual training through My Career and Development Center. Additionally, I have received training and insight into other parts of the business through the Individual Development Plan I set up with my manager.
Kyle J.
Claims Resolution Specialist III –Fastpath Property
Liberty Mutual encourages one-on-one coaching with each employee and their manager. I receive weekly feedback regarding my professional development and I am able to discuss my long-term goals and how to achieve them.
Jenna M.
Inside Auto Claims Representative
My favorite thing about my job is being able to assist customers and walk them through the claims process. I am able to provide them with the expectations of the process and what will happen next.
Tamia McK.
Claims Customer Care Associate
Liberty Mutual genuinely cares for and develops their employees. They also encourage employees to transition within the company and provide a great atmosphere for learning and developing.
Steven N.
Claims Customer Care Associate
You feel part of a team. Everyone is appreciative of your hard work.
Gina D.
Senior Customer Claims Representative
My goal in my position is to create peace of mind with the customer by listening to their specific needs and responding with concern and expertise. As I’ve continued to learn and grow in this position, I’ve expanded my claims knowledge, and providing that expertise to customers is very rewarding. And, I learn something new every day.
Alison W.
Claims Adjuster
Liberty Mutual provides us with a great benefit package, excellent wages, an understanding of the need for work/life balance, and many career growth opportunities. We are also given additional incentives to achieve, such as the Circle of Excellence and the Chairman’s Award.
Jennifer A.
Claims Customer Care Rep
Customer Service
Liberty Mutual strives to develop employees, attempting to keep them indefinitely. Other companies view employees as a body that can sit ata desk and perform a task until that position is no longer needed. Iam empowered every day to do the right thing for our customers and other employees.
Adam H.
Senior Outbound Gold Customer Service Representative
Liberty Mutual strives to develop employees, attempting to keep them indefinitely. Other companies view employees as a body that can sit ata desk and perform a task until that position is no longer needed. Iam empowered every day to do the right thing for our customers and other employees.
Adam H.
Senior Outbound Gold Customer Service Representative
I love the people here. There really is a Liberty Mutual employee community that is hard to describe. We all support each other, even supporting one another between sites. It’s pretty awesome!
Heather H.
CRC Lead &Senior Gold CSR • Spokane, WA
I love the people here. There really is a Liberty Mutual employee community that is hard to describe. We all support each other, even supporting one another between sites. It’s pretty awesome!
Heather H.
CRC Lead &Senior Gold CSR • Spokane, WA
Liberty Mutual strives to develop employees, attempting to keep them indefinitely. Other companies view employees as a body that can sit ata desk and perform a task until that position is no longer needed. Iam empowered every day to do the right thing for our customers and other employees.
Adam H.
Senior Outbound Gold Customer Service Representative
I love the people here. There really is a Liberty Mutual employee community that is hard to describe. We all support each other, even supporting one another between sites. It’s pretty awesome!
Heather H.
CRC Lead &Senior Gold CSR • Spokane, WA
Field Sales
I have coached new sales reps in the KEYS program and the process has been mutually beneficial. Coaching allows me to sharpen my skills while mentoring and benefits the new rep in building a relationship with a more tenured rep.
Samantha J. B.
Executive Sales Representative
I have coached new sales reps in the KEYS program and the process has been mutually beneficial. Coaching allows me to sharpen my skills while mentoring and benefits the new rep in building a relationship with a more tenured rep.
Samantha J. B.
Executive Sales Representative
Working at Liberty Mutual has provided me with the flexibility, earning potential, and autonomy that I was looking for. Because you have the backing of Liberty Mutual, you get to reap the rewards of an amazing benefits package, solid salary, and unlimited commissions without the stress of daily operations of managing an office.
Kryslin J.
Sales Representative II
Working at Liberty Mutual has provided me with the flexibility, earning potential, and autonomy that I was looking for. Because you have the backing of Liberty Mutual, you get to reap the rewards of an amazing benefits package, solid salary, and unlimited commissions without the stress of daily operations of managing an office.
Kryslin J.
Sales Representative II
I have coached new sales reps in the KEYS program and the process has been mutually beneficial. Coaching allows me to sharpen my skills while mentoring and benefits the new rep in building a relationship with a more tenured rep.
Samantha J. B.
Executive Sales Representative
Working at Liberty Mutual has provided me with the flexibility, earning potential, and autonomy that I was looking for. Because you have the backing of Liberty Mutual, you get to reap the rewards of an amazing benefits package, solid salary, and unlimited commissions without the stress of daily operations of managing an office.
Kryslin J.
Sales Representative II
Inside Sales
The culture at Liberty Mutual is more inclusive. There are many different contests to motivate the employees and to make the job more enjoyable. The compensation and bonusesreally reflect the amount of work that you do, therefore I feel like I am respected as an insurance professional.
Sarah R.
Sales Development Specialist
The culture at Liberty Mutual is more inclusive. There are many different contests to motivate the employees and to make the job more enjoyable. The compensation and bonusesreally reflect the amount of work that you do, therefore I feel like I am respected as an insurance professional.
Sarah R.
Sales Development Specialist
My coaches and supervisors gave me all of the tools I needed to do my job and beyond. The management team has acknowledged the hard work I put in and has given me opportunity to coach. My manager even took me on a visit to Plano, Texas to coach there. I love Liberty Mutual as a whole and I look forward to growing with the company for a very long time.
Nicholas H.
Hiring Manager
My coaches and supervisors gave me all of the tools I needed to do my job and beyond. The management team has acknowledged the hard work I put in and has given me opportunity to coach. My manager even took me on a visit to Plano, Texas to coach there. I love Liberty Mutual as a whole and I look forward to growing with the company for a very long time.
Nicholas H.
Hiring Manager
The culture at Liberty Mutual is more inclusive. There are many different contests to motivate the employees and to make the job more enjoyable. The compensation and bonusesreally reflect the amount of work that you do, therefore I feel like I am respected as an insurance professional.
Sarah R.
Sales Development Specialist
My coaches and supervisors gave me all of the tools I needed to do my job and beyond. The management team has acknowledged the hard work I put in and has given me opportunity to coach. My manager even took me on a visit to Plano, Texas to coach there. I love Liberty Mutual as a whole and I look forward to growing with the company for a very long time.
Nicholas H.
Hiring Manager
From Our Employees
Liberty is a flexible, inclusive environment that believes in promoting from within, as well as empowering their employees to improve processes.
Lee S
Underwriting consultant
Without a doubt, it is the people at Liberty that have made my experience so positive. Everyone in this organization is intelligent, driven, and genuine. I am inspired every day by my team and feel lucky to be part of an organization that promotes a people-first culture.
Leslie P
Business strategy director
Without a doubt, it is the people at Liberty that have made my experience so positive. Everyone in this organization is intelligent, driven, and genuine. I am inspired every day by my team and feel lucky to be part of an organization that promotes a people-first culture.
Leslie P
Business strategy director
I knew I wanted to work for an employer that values its employees and gives them lots of meaningful ways to grow. I also wanted to work for a company that truly valued its customers.
Alison W
Claims
I knew I wanted to work for an employer that values its employees and gives them lots of meaningful ways to grow. I also wanted to work for a company that truly valued its customers.
Alison W
Claims
The most satisfying part of my job is being able to work with individuals who are very knowledgeable and love learning. I find it very motivating.
Laqwan B
Product owner
The most satisfying part of my job is being able to work with individuals who are very knowledgeable and love learning. I find it very motivating.
Laqwan B
Product owner
My favorite things about Liberty Mutual are its commitments to innovation, diversity, community involvement, and professional development.
Shaunette O
Customer service
My favorite things about Liberty Mutual are its commitments to innovation, diversity, community involvement, and professional development.
Shaunette O
Customer service
Liberty is a flexible, inclusive environment that believes in promoting from within, as well as empowering their employees to improve processes.
Lee S.
Underwriting Consultant
Without a doubt, it is the people at Liberty that have made my experience so positive. Everyone in this organization is intelligent, driven, and genuine. I am inspired every day by my team and feel lucky to be part of an organization that promotes a people-first culture.
Leslie P.
Business Strategy Director
I knew I wanted to work for an employer that values its employees and gives them lots of meaningful ways to grow. I also wanted to work for a company that truly valued its customers.
Alison W.
Claims
The most satisfying part of my job is being able to work with individuals who are very knowledgeable and love learning. I find it very motivating.
Laqwan B.
Product Owner
My favorite things about Liberty Mutual are its commitments to innovation, diversity, community involvement, and professional development.
Shaunette O.
Customer Service
From Our Employees
Jeff M.
Actuarial Development Program
"My journey at Liberty started in Boston, Massachusetts as an Actuarial summer intern. The experience was so enjoyable that I decided to intern for a second summer in the Seattle office before joining the Actuarial Development Program full-time. My rotation on the Data Science team has only reinforced my decision by helping me grow analytically and professionally."
Jeff M.
Actuarial Development Program
"My journey at Liberty started in Boston, Massachusetts as an Actuarial summer intern. The experience was so enjoyable that I decided to intern for a second summer in the Seattle office before joining the Actuarial Development Program full-time. My rotation on the Data Science team has only reinforced my decision by helping me grow analytically and professionally."
Megan K.
Analyst Development Program
“The Analyst Development Program has given me the technical, analytical, and interpersonal skills that I need to have a successful career, all while allowing me to develop meaningful relationships with my program peers and rotation teams.”
Megan K.
Analyst Development Program
“The Analyst Development Program has given me the technical, analytical, and interpersonal skills that I need to have a successful career, all while allowing me to develop meaningful relationships with my program peers and rotation teams.”
Jenny W.
Financial Management Program
“In my first rotation alone, I’ve had the opportunity to collaborate with analysts and managers across various business functions. It’s rewarding to work with such a supportive team, and to see how my work truly makes an impact.”
Jenny W.
Financial Management Program
“In my first rotation alone, I’ve had the opportunity to collaborate with analysts and managers across various business functions. It’s rewarding to work with such a supportive team, and to see how my work truly makes an impact.”
Billy N.
Summer Associate, Corporate Development Program
"Liberty provides the opportunity to take on challenging and impactful projects, gain exposure to different functions across the organization, develop meaningful relationships in formal and informal settings, and do overseas rotations."
Billy N.
Summer Associate, Corporate Development Program
"Liberty provides the opportunity to take on challenging and impactful projects, gain exposure to different functions across the organization, develop meaningful relationships in formal and informal settings, and do overseas rotations."
Marsilda H.
Corporate Strategy & Research
"One of the main reasons why I enjoy being at Liberty Mutual is the work-life balance. Liberty’s extended maternity leave policy is a major development for an American company, and I am very proud that Liberty is among the first to offer such a benefit to its employees."
Marsilda H.
Corporate Strategy & Research
"One of the main reasons why I enjoy being at Liberty Mutual is the work-life balance. Liberty’s extended maternity leave policy is a major development for an American company, and I am very proud that Liberty is among the first to offer such a benefit to its employees."
My journey at Liberty started in Boston, Massachusetts as an Actuarial summer intern. The experience was so enjoyable that I decided to intern for a second summer in the Seattle office before joining the Actuarial Development Program full-time. My rotation on the Data Science team has only reinforced my decision by helping me grow analytically and professionally.
Jeff M.
Actuarial Development Program
The Analyst Development Program has given me the technical, analytical, and interpersonal skills that I need to have a successful career, all while allowing me to develop meaningful relationships with my program peers and rotation teams.
Megan K.
Analyst Development Program
In my first rotation alone, I’ve had the opportunity to collaborate with analysts and managers across various business functions. It’s rewarding to work with such a supportive team, and to see how my work truly makes an impact.
Jenny W.
Financial Management Program
Liberty provides the opportunity to take on challenging and impactful projects, gain exposure to different functions across the organization, develop meaningful relationships in formal and informal settings, and do overseas rotations.
Billy N.
Summer Associate, Corporate Development Program
One of the main reasons why I enjoy being at Liberty Mutual is the work-life balance. Liberty’s extended maternity leave policy is a major development for an American company, and I am very proud that Liberty is among the first to offer such a benefit to its employees.