This site uses cookies. To find out more, see our Cookies Policy

Risk Management Analyst - A&H in Milwaukee, WI at National General Insurance

Date Posted: 1/28/2019

Job Snapshot

Job Description

Primary Purpose:

Responsible for mitigating potential risk through evaluation of claims referred for misrepresentation review to determine fraud or intentional misrepresentation. Review and investigate referrals utilizing company procedures, workflows, claim activity, contract language, policy benefits, and medical records.

Essential Duties and Responsibilities:

Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.

  • Determine if a misrepresentation and/or pre-existing investigation is warranted through the review of company procedures and workflows, claim activity, policy benefits, and medical records
  • Apply appropriately the pre-existing and misrepresentation contract language with review of Medical Records
  • Collaborate with various lines of business including product, actuary, compliance, legal, distribution partners, third party administrators, and other departments
  • Apply knowledge and sound judgement in review of medical records in accordance with policy contracts 
  • Assist with special projects or requests

Minimum Skills and Competencies:

The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Bachelor Degree or in-lieu of degree equivalent education, training and work-related experience
  • 5+ years of medical underwriting and health insurance industry business experience
  • Ability to analyze and interpret medical records, physician office notes, medical literature, CPT/ICD10 coding, EOBs/submitted claims, and medical review data
  • Ability to apply contract language to review of medical records
  • Critical thinking skills and display of sound judgment
  • Must possess effective verbal and written communication skills
  • Strong problem solving and decision making skills
  • Ability to process complex data and information from multiple sources, make decisions based on this data, and effectively communicate the related required actions to a broad audience
  • Requires good organizational skills and the ability to complete multiple complex tasks in a timely fashion
  • Ability to present a professional image and to encourage peers to do the same
  • Ability to work independently and as a team member
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)

Desired Skills:

  • Fluent in medical terminology and solid understanding of human anatomy
  • Ability to think strategically and conceptually with a focus on impacts and outcomes

Job Requirements


About National General Holdings:

National General Holdings Corp. is headquartered in New York City. National General traces its roots to 1939, has a financial strength rating of A– (excellent) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, supplemental health, and other niche insurance products. We are a specialty personal lines insurance holding company. Through our subsidiaries, we provide a variety of insurance products, including personal and commercial automobile, homeowners, umbrella, recreational vehicle, supplemental health, lender-placed and other niche insurance products.

National General is a fast paced, dynamic, and entrepreneurial organization. Our team members live by and exemplify what we call the 4Es. At National General, we are Energized, Engaged, Empowered, and we Execute every day in order to provide an exceptional experience for our customers! We are passionate about our organization and the value that we add every day. A successful candidate with National General will embody the 4Es. Our team is poised to outperform the competition. We are National General Insurance and with us you can be extraordinary! Come join our team!

Companies and Partners

Direct General Auto & Life, Personal Express Insurance, Century-National Insurance, ABC Insurance Agencies, NatGen Preferred, NatGen Premier, Seattle Specialty, National General Lender Services, ARS, RAC Insurance Partners, Mountain Valley Indemnity, New Jersey Skylands, Adirondack Insurance Exchange, VelaPoint, Quotit, HealthCompare, AHCP, NHIC, Healthcare Solutions Team, North Star Marketing, Euro Accident.

In addition to a phenomenal career opportunity, National General Insurance offers an excellent benefits package including:

• Paid Training
• Medical, Dental, Vision benefits
• Wellness Programs
• Life and Short/Long Term Disability Insurance
• 401k w/ Company Match
• Company Paid Holidays & Generous Time-off policy
• Employee Discount Program
• Career Advancement and Development Opportunities
• On-site Healthcare Clinic (Winston-Salem and Cleveland offices)
• On-site Fitness Center (Cleveland and Dallas offices)
• Subsidized parking (Cleveland office)

National General Holdings Corp. is an Equal Opportunity (EO) employer – Veterans/Disabled and other protected categories. All qualified applicants will receive consideration for employment regardless of any characteristic protected by law. Candidates must possess authorization to work in the United States, as it is not our practice to sponsor individuals for work visas.

In the event you need assistance or accommodation in completing your online application, please contact NGIC main office by phone at (336) 435-2000.



  1. Insurance Adjuster Jobs
  2. Claims Adjuster Jobs