Are you looking to make an impactful difference in your work, yourself, and your community? Why settle for just a job when you can land a career? At ICW Group, we are hiring team members who are ready to use their skills, curiosity, and drive to be part of our  journey as we strive to transform the insurance  carrier space. We're proud to be in business for over 50 years, and its change agents like yourself that will help us continue to deliver our mission to create the best insurance experience possible.

Headquartered in San Diego with regional offices located throughout the United States, ICW Group has been named for ten consecutive years as a Top 50 performing P&C organization offering the stability of a large, profitable and growing company combined with a focus on all things people. It's our team members who make us an employer of choice and the vibrant company we are today. We strive to make both our  internal and external communities better everyday! Learn more about why you want to be here!

PURPOSE OF THE JOB 

The purpose of this job is to provide quantitative and qualitative data analysis and report trends, insights, and make recommendations to leaders. This role will produce reports and craft presentations to drive insights into business performance. This position exists to provide data analytics and field case management support to the managed care and cost containment team in the execution of the team goals.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Provides oversight for all vended Nurse Case Management (NCM) products, including Field Case Management (FCM) and Nurse Triage programs. 

• Builds strong relationship with external vendors and serves as liaison between the claims department and vendors.
• Acts as a gatekeeper for referrals between in-house telephonic nurse case managers, claims examiners and vendors.  Reviews open referrals and ensures closure in a timely manner.
• Champions the identification, evaluation, and addition of new vendors to current field case management panel.  Coordinates the request for proposal (RFP) process with Purchasing department.
• Coordinates with Information Technology (IT) to connect new vendors to internal systems.
• Reviews and analyzes reports on FCM program metrics to identify trending and to overcome barriers to meeting goals and objectives.  

Provides cost containment program support. 

• Provides support to claims and audit teams as needed for medical management oversight results and data analysis.
• Collaborates closely with Cost Management Manager in tracking, resolution gathering, and trending of cost management issues related to bill review, case management and utilization review.
• Works closely with Case Management Manager and Director to perform quarterly reporting on program impact/results.
• Provides oversight of reporting processes for quarterly true-up of account balances for preferred vendor partners (receivables/payables/payments) and requests any additional information needed. 
• Assists with ad-hoc Cost Containment Team initiatives and special projects.

Provides quantitative and qualitative data analysis and reporting of patterns, insights, and trends to department leadership.

• Collects, aggregates, and analyzes data from internal systems and vendor partners to drive insights into business performance. 
• Creates reports which integrate data from multiple sources to detect trends and areas of concern, makes recommendations to improve performance. 
• Crafts presentations for management to aid in decision making. Serves as a Subject Matter Expert (SME) as well as content gatherer to present and explain the data analysis and recommendations.
• Analyzes and evaluates current business processes and requirements, and makes recommendations to management for new, more efficient, processes.
• Analyzes claims data focusing on outcomes and vendor performance.

SUPERVISORY RESPONSIBILITIES 

This role does not have supervisory responsibilities.

EDUCATION AND EXPERIENCE 

Bachelors from a college or university required with a major in Business, Computer Science, Information Technology, or related field. Additional experience may be considered in lieu of degree. Minimum 4 years of experience in data analysis or similar area required. Experience with managed care preferred.  

CERTIFICATES, LICENSES, REGISTRATIONS 

None required.

KNOWLEDGE AND SKILLS

Understanding of Workers’ Compensation, Workers’ Compensation Managed Care processes, Utilization Review, Telephonic Nurse Case Management, and Field Nurse Case Management. Strong understanding of data analysis concepts and principles. Knowledge of medical terminology. Strong computer skills with knowledge of Microsoft Office Suite: Word, Power Point, Tableau, with strong skills in Excel. Superior customer service and collaboration skills with internal and external stakeholders.  Excellent verbal and written communication skills. Solid command of English language, grammar, and punctuation, required.  Ability to create presentations and present to management. Ability to communicate with customers with courtesy and professionalism over the phone. Ability to add, subtract, multiply, and divide. Ability to efficiently organize workload with strong attention to detail. Ability to work independently without direct supervision. 

PHYSICAL REQUIREMENTS  

Office environment – no specific or unusual physical or environmental demands and employees are regularly required to sit, walk, stand, talk, and hear.  

WORK ENVIRONMENT  

This position operates in an office environment and requires the frequent use of a computer, telephone, copier, and other standard office equipment. 

We are currently not offering employment sponsorship for this opportunity

#LI-ET1 #LI-Hybrid

The current range for this position is

$68,481.25 - $115,489.01

This range is exclusive of fringe benefits and potential bonuses.  If hired at ICW Group, your final base salary compensation will be determined by factors unique to each candidate, including experience, education and the location of the role and considers employees performing substantially similar work.

WHY JOIN ICW GROUP?
•    Challenging work and the ability to make a difference
•    You will have a voice and feel a sense of belonging
•    We offer a competitive benefits package, with generous medical, dental, and vision plans as well as 401K retirement plans and company match
•    Bonus potential for all positions
•    Paid Time Off with an accrual rate of 5.23 hours per pay period (equal to 17 days per year)
•    11 paid holidays throughout the calendar year
•    Want to continue learning? We’ll support you 100%

ICW Group is committed to creating a diverse environment and is proud to be an Equal Opportunity Employer. ICW Group will not discriminate against an applicant or employee on the basis of race, color, religion, national origin, ancestry, sex/gender, age, physical or mental disability, military or veteran status, genetic information, sexual orientation, gender identity, gender expression, marital status, or any other characteristic protected by applicable federal, state or local law.

___________________

Job Category

Claims