Nurse - Group Insurance Claims
Location:
Roseland , New Jersey
Posted:
October 18, 2017
Reference:
DIS0009W
The Clinician will be responsible for the following:
  • Assists claims managers in managing claims by reviewing medical information to determine disability status, appropriateness of care, and help develop customized RTW plans.
  • Develops action plans for case resolution and for facilitation of appropriate claim decisions including implementation of obtaining additional medical documentation.
  • Actively intervenes with claimants and health care providers for initial information, status and clarification.
  • Determines the requirements for additional information/documentation including: Medical records, job descriptions, and additional medical authorization if necessary.
  • Formulates correspondence and questions for both providers and IMEs and includes appropriate documentation.
  • Determines disposition or next steps in continued case management for the Disability Claim Manager.

Qualifications:
  • College degree in nursing preferred
  • Minimum of 2 years hospital experience preferred (Emergency Room Critical Care, Orthopedics, Adult Medical or Surgical or Psychiatric)
  • Experience in Disability Case Management, Occupational Health Nursing, or Workers Compensation preferred
  • Excellent oral and written communication and critical thinking skills required
  • Computer skills including Windows required

A little about us:
Prudential was founded on the belief that being financially prepared is a right, not a privilege.

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