Analyst, Claims-Pet

Are you passionate about being part of a team at a Fortune 100 company with nearly $70 billion in annual sales that delivers extraordinary care to help individuals and businesses prepare for and protect their future? If so, then Nationwide Financial could be the place for you! At Nationwide®, “on your side” goes beyond just words. Our customers and partners are at the center of everything we do and we’re looking for associates who are passionate about delivering extraordinary care.

Job Description Summary

Would you get a sense of satisfaction by providing exceptional service to resolve issues and uncover solutions that help protect our customers’ pets when they most need us? Can you apply your veterinary medical expertise to claims handling and adjudication? If this sounds like a great opportunity, we want to know more about you!

As an Analyst, you'll handle new and pending medical claims by requesting, compiling and reviewing coverage and media information to promptly and effectively determine the correct claim adjudication action. We'll count on you to enter accurate coding information in the system ensuring that the submitted invoice balances with the system input information to complete the claim adjudication process.

Job Description

Key Responsibilities:

• Processes all new and pending medical claims according to the appropriate workflow. Reviews veterinary diagnosis and codes claims according to policy provisions. Ensures completion of claims by coding and processing or sending claims to appropriate workflow.
• Determines coverage (i.e., pre-existing conditions, breed-specific and/or hereditary conditions) and approves benefits and eligibility of each claim based on the terms and conditions of the policy.
• Accurately processes claims based on established criteria, provider contract plan and employer group provisions.
• Requests, reviews and evaluates requested medical records or treatment notes for determination of resolving claims.
• Ensures proper documentation in compliance with company policies and practices. Records the final disposition of claims, including denial and/or issuing payment.
• Identifies and advises management of questionable claims and questionable risks.
• May perform other responsibilities as assigned.
• Reporting Relationships: Supervisor, Claims
• Typical Skills and Experiences: Education: High school, vocational or technical school studies. Undergraduate degree in biology, zoology or related animal science field preferred.
• License/Certification/Designation: State licensing and/or other certification as required. Associates must acquire the required Federal and/or state licenses/registrations within the time period designated by the business unit. Additional licenses/registrations may be required when new products and services are implemented. If an associate fails to acquire required licenses/registrations within the designated time period, the associate maybe ineligible to continue in the position.
• Experience: Three to five years of veterinary claims experience or equivalent training in a veterinary clinic / hospital position under the direct supervision of a veterinarian/veterinary technician preferred.
• Knowledge, Abilities and Skills: Proven understanding of veterinary medical practices and treatment. Ability to understand and use Nationwide Insurance policies, riders and endorsements and be able to recognize and resolve questionable coverage situations. Ability to read, analyze, and interpret documents. Ability to solve practical problems. Ability to meet internal customer needs and provide service by informing customers of the claims process and ensuring a positive customer experience. Written and verbal communication skills for contact with policyholders, claimants, physicians, medical staff, etc. Requires use of basic math (addition, subtraction, multiplication and division). Ability to operate personal computer and software for claims-related and other business applications.
• Other criteria, including leadership skills, competencies and experiences may take precedence.
• Staffing exceptions to the above must be approved by the hiring manager’s leader and Human Resources Business Partner.
• Values: Regularly and consistently demonstrates Nationwide Values.
• Job Conditions: Overtime Eligibility: Non-exempt (Eligible)
• Working Conditions: Normal office environment. This position requires the ability to work non-standard hours.
• ADA: The above statements cover what are generally believed to be principal and essential functions of this job. Specific circumstances may allow or require some people assigned to the job to perform a somewhat different combination of duties.
• We currently anticipate accepting applications until 10/29/2026. However, we encourage early submissions, as the posting may close sooner if a strong candidate slate is identified before the deadline.