Analyst, Claims-Pet

Are you passionate about being part of a team that delivers extraordinary care to help individuals and businesses prepare for and protect their retirement? If so, then Nationwide Financial could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care.

Your career with Nationwide will begin in February 2025, with a training program that will go through March 2025. During training, you will be working Monday-Friday 6:30am-2:45pm PST. After training, you will work with your supervisor to select a shift that works for you; hours would be anytime during the range of 5am-7pm (in your time zone) Monday-Friday, with weekend opportunities available.

This role will be fully remote.

 

The ideal candidate will have the ability to:

• Review and process pet medical claims using veterinary knowledge.
• Deliver quality service and timely results to policyholders.
• Communicate and collaborate effectively with internal and external stakeholders.
• Analyze and resolve complex claims issues using critical thinking and problem-solving skills.

 

Compensation band: D2

#LI-LP1

Job Description Summary

Would you get a sense of satisfaction by providing exceptional service to resolve issues and uncover solutions that help protect our customers’ pets when they most need us? Can you apply your veterinary medical expertise to claims handling and adjudication? If this sounds like a great opportunity, we want to know more about you!

As an Analyst, you'll handle new and pending medical claims by requesting, compiling and reviewing coverage and media information to promptly and effectively determine the correct claim adjudication action. We'll count on you to enter accurate coding information in the system ensuring that the submitted invoice balances with the system input information to complete the claim adjudication process.

Job Description

Key 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 (i.e., pre-existing conditions, breed-specific and/or hereditary conditions) 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.

Reporting Relationships: Supervisor, Claims

Typical Skills and Experiences:

Education: High school, vocational or technical school studies. Undergraduate degree in biology, zoology or related animal science field preferred.

License/Certification/Designation: State licensing and/or other certification as required. Associates must acquire the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails to acquire required licenses/registrations within the designated time period, the associate maybe ineligible to continue in the position.

Experience: Three to five years of veterinary claims experience or equivalent training in a veterinary clinic / hospital position under the direct supervision of a veterinarian/veterinary technician preferred.

Knowledge, Abilities and Skills: Proven understanding of veterinary medical practices and treatment. Ability to understand and use Nationwide Insurance policies, riders and endorsements and be able to recognize and resolve questionable coverage situations. Ability to read, analyze, and interpret documents. Ability to solve practical problems. Ability to meet internal customer needs and provide service by informing customers of the claims process and ensuring a positive customer experience. Written and verbal communication skills for contact with policyholders, claimants, physicians, medical staff, etc. Requires use of basic math (addition, subtraction, multiplication and division). Ability to operate personal computer and software for claims-related and other business applications.

Other criteria, including leadership skills, competencies and experiences may take precedence. 

Staffing exceptions to the above must be approved by the hiring manager’s leader and Human Resources Business Partner.

Values: Regularly and consistently demonstrates Nationwide Values.

Job Conditions:

Overtime Eligibility: Non-exempt (Eligible)

Working Conditions: Normal office environment.

ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties. 

We currently anticipate accepting applications until 12/18/2024. However, we encourage early submissions, as the posting may close sooner if a strong candidate slate is identified before the deadline.

Benefits

We have an array of benefits to fit your needs, including: medical/dental/vision, life insurance, short and long term disability coverage, paid time off with newly hired associates receiving a minimum of 18 days paid time off each full calendar year pro-rated quarterly based on hire date, nine paid holidays, 8 hours of Lifetime paid time off, 8 hours of Unity Day paid time off, 401(k) with company match, company-paid pension plan, business casual attire, and more. To learn more about the benefits we offer, click here.

Nationwide is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive culture where everyone feels challenged, appreciated, respected and engaged. Nationwide prohibits discrimination and harassment and affords equal employment opportunities to employees and applicants without regard to any characteristic (or classification) protected by applicable law.

This position could be filled within any of the lower 48 U.S. states.

#claims

Smoke-Free Iowa Statement: Nationwide Mutual Insurance Company, its affiliates and subsidiaries comply with the Iowa Smokefree Air Act. Smoking is prohibited in all enclosed areas on or around company premises as well as company issued vehicles. The company offers designated smoking areas in which smoking is permitted at each individual location. The Act prohibits retaliation for reporting complaints or violations. For more information on the Iowa Smokefree Air Act, individuals may contact the Smokefree Air Act Helpline at 888-944-2247.

For NY residents please review the following state law information: Notice of Employee Rights, Protections, and Obligations LS740 (ny.gov) https://dol.ny.gov/system/files/documents/2022/02/ls740_1.pdf

Nationwide pays on a geographic-specific salary structure and placement within the actual starting salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity and location of the role as well as the cost of labor in the market; and other conditions of employment. If a Sales job, Sales Incentives, based on performance goals are possible in addition to this range.

The national salary range for Analyst, Claims - Pet : $42,315.00-$79,400.00

The expected starting salary range for Analyst, Claims - Pet : $42,600.00 - $64,000.00

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