Provide technical support to the Claims Department in the evaluation of psychiatric claims. Serve as liaison between the Claims staff and all physician constituents, both within and outside of Northwestern Mutual, for psychiatric aspects of claims. Advocate the Company's psychiatric position on claims and resolve disputes on the psychiatric aspects of them. Monitor and continually improve protocols for the psychiatric management of claims.

1.Provide expert psychiatric technical support to the Claims Department in order to ensure the timely and consistent review of the psychiatric components of claims through evaluation of medical records (Attending Physician Statements, treatment records, test results, Evaluative Medical Examination (EME) reports, and Paper Review reports), provide opinions to Claim analysts, and identify when additional information is needed.

2.Identify the need for and coordinate the handling of claim referrals to psychiatric staff or to EME/Paper Review physicians, and act as the liaison between the Claims Department and all psychiatric resources psychiatric consultants, EME physicians, and other outside psychiatric experts to ensure that psychiatric reviews are thorough and complete and adhere to the claim philosophy of the Claims Department. Triage and review all psychiatric cases being referred to Psychiatric Experts to determine level of review required.

3.Communicate with and advocate Company's position to attending physicians and physician insureds regarding insured's psychiatric condition, clinical findings, significance of and support for claimed limitations, appropriateness of treatment and alternatives, expected duration of claim, and potential for rehabilitation or return to work in order to assist the Claims Department in expediting their psychiatric reviews and providing the expected levels of customer service. Resolve psychiatric disputes, via negotiation and/or participation in litigation.

4.Research, create and present all psychiatric education and training for the Claims Department and provide new analyst psychiatric training classes and prepare periodic presentations to help ensure efficiency and consistency in administering psychiatric claim protocols and processes.Minimum of a Master's Degree in Social Work or Master's Degree in Psychology

Current LCSW or LPC state license

Minimum of 5-7 years of clinical mental health experienceExcellent interpersonal skills and proven ability to work effectively with others at all experience levelsSuperior written and verbal communication skills.Strong analytical skills and proven ability to exercise sound judgment and decision-making skills.Demonstrated leadership abilityTeaching experience in a staff development role, unit management experience or other equivalent responsible professional/administrative experience.Knowledge of disability insurance or prior experience in insurance claim management preferred.Knowledge of computer functions and experience in a Windows environment.

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We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more.

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Northwestern Mutual is an equal opportunity employer who welcomes and encourages diversity in the workforce. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.

Skills

Analytical Thinking (NM) - Advanced, Dispute Resolution (NM) - Advanced, Training, Educating & Awareness (NM) - Advanced, Customer Centricity (NM) - Advanced, Claims Policies & Practices (NM) - Advanced, Clinical Mental Health Acumen (NM) - Expert, Medical Case Consultation (NM) - Expert, Coaching & Mentoring (NM) - Advanced, Insurance Acumen (NM) - Advanced, Information Gathering (NM) - Advanced, Medical Acumen (NM) - Expert, Attention to Detail (NM) - Advanced, Claims Acumen (NM) - Advanced, Adaptive Communication (NM) - Advanced, Decision Making (NM) - Expert, Claims Advocacy (NM) - Expert, Learning Agility & Critical Thinking (NM) - Advanced, Data Application (NM) - Intermediate

FIND YOUR FUTURE

We’re excited about the potential people bring to Northwestern Mutual. You can grow your career here while enjoying first-class perks, benefits, and our commitment to a culture of belonging.

• Flexible work schedules
• Concierge service
• Comprehensive benefits
• Employee resource groups