Nurse Claims Analyst

Zipliens is a leading lien resolution company that specializes in streamlining the lien process for personal injury law firms. We are looking for proactive, results-driven individuals to join our dynamic team.

Zipliens is seeking a Nurse Claims Analyst to provide clinical expertise that strengthens the accuracy and reliability of our Mass Tort lien resolution process. Health plans often submit reimbursement claims that include extensive medical itemizations, and it is critical that only treatment directly related to the underlying litigation is considered. The Nurse Claims Analyst will leverage clinical judgment and familiarity with medical coding (ICD/CPT) to support this process, ensuring reviews are accurate, consistent, and defensible. As a clinical Subject Matter Expert (SME), the Nurse Claims Analyst will support the development of clear review protocols, provide guidance on complex or disputed claims, and contribute to process improvements that uphold the highest standards of quality and fairness.

Conduct high-volume QA reviews of claimant-level medical records (up to 1,000 per week), using clinical judgment and knowledge of medical coding to determine relatedness to the underlying litigation. Help create and establish medical claim audit protocols to enable consistent and defensible determinations. Use Excel/Google Sheets to efficiently manage and analyze large datasets, creating workflows that streamline reviews and reduce the need for one-off line-by-line analysis. Document review findings and rationales clearly and accurately for use by internal teams and clients. Identify trends or recurring issues in claim reviews and recommend updates to processes or protocols to improve consistency and accuracy. Support knowledge sharing by documenting review standards and providing clinical guidance to internal team members and vendors. Adapt review approach across multiple claim types to meet evolving client and project needs. Ensure reviews and determinations meet accuracy, quality, and productivity standards that support reliable client outcomes. Contribute subject matter expertise to reports, analysis, and special projects that strengthen review protocols and client deliverables.