Medical Bill Review Nurse II 119265 Zurich Insurance is seeking a skilled Medical Bill Review Senior Nurse to join our team in Schaumburg, IL. In this role, you will review highly complex medical bills and reports, including intricate medical jurisdictions, to ensure compliance with regional, national, and local regulations, applicable coding guidelines, and contractual agreements. You will determine fair and reasonable medical charges for compensable injuries, ensuring optimal benefits for claimants while maintaining cost-efficiency for the carrier. Additionally, you will proactively address customer needs by responding to inquiries promptly, providing timely updates, and resolving assigned medical bills using your technical expertise.. Your responsibilities will include accurately inputting data into systems to support performance analysis and contributing to operational efficiency through process improvements and problem-solving. You will monitor compliance with legal and regulatory controls, ensuring all practices adhere to established guidelines. As a subject matter expert, you will support the medical bill review, sharing your expertise to enhance team performance and uphold Zurich’s commitment to excellence. **Key Responsibilities:** + Analyze and resolve complex medical billing disputes by collaborating with corporate law, Technical Claims, and other stakeholders. + Participate in medical bill hearings or depositions as required. + Validate medical treatments and charges against compensable injuries using medical expertise. + Ensure compliance with Best Practices by accurately reviewing medical bills within regulatory timelines. + Identify and report suspicious billing activities to the Special Investigations Unit. + Resolve escalated billing issues by applying medical expertise and adhering to policies and procedures. + Respond promptly and professionally to customer inquiries to ensure satisfaction. + Contribute to quality assurance by participating in peer review audits and adhering to Best Practices. + Support process improvements by identifying issues, recommending solutions, and implementing customer initiatives. + Serve as a technical subject matter expert by training and sharing knowledge with the team. + Maintain confidentiality of claims information to protect Zurich’s reputation. **Required Qualifications:** + Bachelor’s degree and 2+ years of experience in Critical Care, Emergency Room, Medical-Surgical, or Operating Room settingsOR + Associate degree and 4+ years of experience in the areas listed above + Active Registered Professional Nurse license + Customer service experience + Knowledge of CPT, ICD-9, ICD-10 codes, and medical terminology **Preferred Qualifications:** + 2+ years of experience in Utilization Review, Case Management, Workers' Compensation, or Medical Bills and Medical Reports. + Strong Clinical and medical experience + Experience working with external vendors + Experience with Audit review + Strong communication and problem-solving skills + Knowledge of the insurance industry, claims processes, and regulatory environment + Additional Requirements + Willingness to travel as needed + Availability for extended hours during peak periods + Valid driver’s license + Successful completion of any required licensing exams At Zurich, compensation for roles is influenced by a variety of factors, including but not limited to the specific office location, role, skill set, and level of experience. In compliance with local laws, Zurich commits to providing a fair and reasonable compensation range for each role. For more information about our Total Rewards, please clickhere (https://www.zurichna.com/careers/benefits) . Additional rewards may encompass short-term incentive bonuses and merit increases. We encourage candidates with salary expectations beyond the provided range to apply, as they will be considered based on their experience, skills, and education. The salary indicated represents a nationwide market range and has not been adjusted for geographic differentials pertaining to the location where the position may be filled. The proposed salary rangefor this position is $69,700.00 – $114,100.00, with short-term incentive bonus eligibility set at 10%. As an insurance company, Zurich is subject to 18 U.S. Code § 1033. As a condition of employment at Zurich, employees must adhere to any COVID-related health and safety protocols in place at that time ( https://www.zurichna.com/careers/faq ). A future with Zurich. What can go right when you apply at Zurich? Now is the time to move forward and make a difference. At Zurich, we want you to share your unique perspectives, experiences and ideas so we can grow and drive sustainable change together. As part of a leading global organization, Zurich North America has over 150 years of experience managing risk and supporting resilience. Today, Zurich North America is a leading provider of commercial property-casualty insurance solutions and a wide range of risk management products and services for businesses and individuals. We serve more than 25 industries, from agriculture to technology, and we insure 90% of the Fortune 500®. Our growth strategy is not limited to our business. As an employer, we strive to provide ongoing career development opportunities, and we foster an environment where voices are diverse, behaviors are inclusive, actions drive equity, and our people feel a sense of belonging. Be a part of the next evolution of the insurance industry. Join us in building a brighter future for our colleagues, our customers and the communities we serve. Zurich maintains a comprehensive employee benefits package for employees as well as eligible dependents and competitive compensation. Please clickhere (https://www.zurichna.com/careers) to learn more. As a global company, Zurich recognizes the diversity of our workforce as an asset. We recruit talented people from a variety of backgrounds with unique perspectives that are truly welcome here. Taken together, diversity and inclusion bring us closer to our common goal: exceeding our customers’ expectations. Zurich does not discriminate on the basis of age, race, ethnicity, color, religion, sex, sexual orientation, gender expression, national origin, disability, protected veteran status or any other legally protected status. EOE disability/vet Zurich does not accept unsolicited resumes from search firms or employment agencies. Any unsolicited resume will become the property of Zurich American Insurance. If you are a preferred vendor, please use our Recruiting Agency Portal for resume submission. Location(s): AM - Schaumburg Remote Working: Hybrid Schedule: Full Time Employment Sponsorship Offered: No Linkedin Recruiter Tag: #LI-MD1 #LI-ASSOCIATE #LI-HYBRID