Bill Review Nurse

Posted 4 Days Ago
Be an Early Applicant
2 Locations
Hybrid
77K-109K Annually
Expert/Leader
Insurance
The Role
Reviews facility and professional medical bills against records, diagnoses, and agreements; negotiates pre-surgical services; audits for leakage and process improvements; advises claims staff on medical cost-control procedures; provides technical guidance; and may coach or manage staff. Requires expert managed-care knowledge, advanced case-management skills, analytical ability, and discretion with confidential information.
Summary Generated by Built In

Summit provides independent insurance agents and their clients with market-leading workers’ comp insurance and elite customer service. We’re growing and currently serve more than 7,000 independent agents and 31,000 policyholders across the South, Midwest, and Mid-Atlantic.


Our strength comes from a single-minded focus on workers’ comp and a commitment to long-term customer relationships. Summit is who you turn to when you need a specialist who not only knows workers’ comp but also gets to know your business and your priorities.


Our field team members are located in every state in which we operate.


Summit is a member of the Great American Insurance Group where our highest goal is for all employees to feel included, respected, and empowered to perform at their best.

This position is not eligible for employment visa sponsorship. Applicants must be authorized to work in the United States without the need for current or future sponsorship.

Essential Job Functions and Responsibilities

  • Reviews Facility and Professional bills as it compares with medical records, diagnosis & agreements for appropriateness or inconsistencies.
  • Negotiates Pre-Surgical Services.
  • Performs audits seeking potential leakage and/or system or procedural improvements.
  • Provides professional advice and expertise to Claims staff in developing and providing medical and cost control procedures.
  • Provides technical advice to lower-level associates and other functional areas.
  • Assists with special projects as needed
  • May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports.
  • Performs other duties as assigned.
  • Great American’s culture is built on connection, shared learning, and strong relationships. To support this, employees in this role are expected to be on-site four days a week, with the flexibility to work one day remotely. Core in-office days are Tuesday–Thursday, with the fourth day determined by business needs.
  • The person hired for this position may work full-time remote depending on availability.

#LI-Hybrid 


Job Requirements

Education: Bachelor’s degree in Healthcare Management, Nursing, or a related field.  R.N. (Registered Nurse) required.Experience: Generally, a minimum of 14 years of case management or managed care experience.Scope of Job/Qualifications: Expert knowledge of managed care laws and regulations. Advanced ability to identify and address nuanced details that may impact the effective management of a case. Demonstrated expert proficiency in organizing and prioritizing caseloads, ensuring timely completion. Excellent interpersonal and communication skills to collaborate with appropriate parties to ensure thorough and effective case management. Stays informed about emerging legislation and industry standards. Proven ability to handle confidential information with discretion. Advanced analytical skills with the ability to use data to analyze complex situations, identify problems, and develop effective solutions. Recognized as a subject matter expert on the team and in the organization.

Company:

SCI Summit Consulting, LLC


Salary Range:

$76,950.00 -$108,870.00

Benefits:

We offer competitive benefits packages for full-time and part-time employees*. Full-time employees have access to medical, dental, and vision coverage, wellness plans, parental leave, adoption assistance, and tuition reimbursement. Full-time and eligible part-time employees also enjoy Paid Time Off and paid holidays, a 401(k) plan with company match, an employee stock purchase plan, and commuter benefits.

 

Compensation varies by role, level, and location and is influenced by skills, experience, and business needs. Your recruiter will provide details about benefits and specific compensation ranges during the hiring process. Learn more at http://www.gaig.com/careers.

 

*Excludes seasonal employees and interns.

Skills Required

  • Bachelor's degree in Healthcare Management, Nursing, or a related field
  • Registered Nurse (R.N.) license or credential
  • Minimum of 14 years of case management or managed care experience
  • Expert knowledge of managed care laws and regulations
  • Advanced ability to identify and address nuanced case-management details
  • Expert proficiency organizing and prioritizing caseloads for timely completion
  • Excellent interpersonal and communication skills
  • Knowledge of emerging legislation and industry standards
  • Ability to handle confidential information with discretion
  • Advanced analytical and problem-solving skills

Great American Insurance Group Compensation & Benefits Highlights

The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about Great American Insurance Group and has not been reviewed or approved by Great American Insurance Group.

  • Leave & Time Off Breadth — PTO, paid holidays, and paid parental leave are positioned as generous from the first year. These time‑off provisions are seen as core strengths of the total package.
  • Healthcare Strength — Health coverage includes comprehensive medical, dental, and vision options supported by HSA and FSA programs. Wellness resources such as EAP access, fitness facilities or reimbursements, and instructor‑led classes broaden the offering.
  • Retirement Support — Immediate 401(k) eligibility with a competitive company match and potential discretionary retirement contributions support long‑term savings. An employee stock purchase option and various discounts further reinforce financial benefits.

Great American Insurance Group Insights

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The Company
HQ: Cincinnati, OH
4,738 Employees

What We Do

Based in Cincinnati, Ohio, the operations of Great American Insurance Group are engaged primarily in property and casualty insurance, focusing on specialty commercial products for businesses. We have more than 30 specialty property and casualty insurance businesses, and in 2021, approximately 50% of our gross written premium in our property and casualty operations was generated by business units with a Top 10 market ranking. Great American Insurance Company has received an "A"​ (Excellent) or higher rating from the AM Best Company for more than 110 years (most recent rating evaluation of "A+"​ (Superior) affirmed December 3, 2021). The members of Great American Insurance Group are subsidiaries of American Financial Group, Inc. (AFG), also based in Cincinnati, Ohio.

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