Risk Management Support Specialist in Milwaukee, WI at National General Insurance

Date Posted: 10/29/2018

Job Snapshot

Job Description

Primary Purpose:

The Risk Management Support Specialist supports the Medical Management Team by gathering, reviewing, logging/tracking referrals, requesting medical records, requesting authorizations, assigning additional medical records received, following up on status requests received from our claims third party administrator,  following up on medical records requested, authorizations requested,  additional medical records required.



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.

  • Review and organize assigned reports to identify follow-up functions for assignment purposes within the Medical Management area (eligibility verification, requesting medical records, initiation of benefit review, etc) to further assist the clinical and non-clinical staff functions.
  • Log referrals and maintain additional databases according to established work-flows. Complete system documentation according to department policies and workflows.
  • Preview of various referrals for completion of information for review.
  • Request/obtain authorizations from members.
  • Request required medical records from medical record retrieval vendor.
  • Request required/and or additional medical information from claims vendor using verbal and written communication.
  • Identifying trends/issues related to the workflow process and assist with communication between claims, customer service, and medical management.
  • Provide administrative support to the medical management staff.
  • Perform other administrative duties as assigned.



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’s Degree or in-lieu of degree equivalent education, training and work-related experience.
  • 3 years of experience with health insurance processes and terminology.
  • 1 year of customer service experience, managed care experience or health insurance experience.
  • 1 year of working knowledge of basic health insurance and medical terminology.
  • 1-2 years of experience working with ICD-10 and CPT coding
  • Knowledge of the difference between clinical and non-clinical decisions.
  • Excellent word processing and data entry skills with the ability to perform accurate data entry.
  • Knowledge and ability to utilize computer skills (Windows, EXCEL, Word, e-mail).
  • Data gathering skills as well as the ability to work with minimal supervision.
  • Basic claims processing knowledge (preferred).
  • Ability to communicate effectively through letter writing.
  • Requires the ability to follow written procedures.
  • Great organizational skills and the ability to multitask in a timely fashion.
  • Knowledge of the difference between clinical and non-clinical decisions.
  • Excellent verbal and written communication skills.
  • Strong interpersonal skills and the ability to maintain objectively while dealing with conflict and often sensitive information. 
  • The ability to work both independently and in a team environment.

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.



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