Associate Claims Clinical Specialist

About the role

The position of Associate Claims Clinical Specialist plays a leading role in the insured or member’s assessment process. We provide services to a variety of clients, all that require your deep knowledge of long-term care needs of an aging or chronically ill population. You will be part of a remote team of clinicians that spend their days reviewing clinical assessments completed by field assessors and writing Plans of Care for Long Term Care Insurance and other government sponsored insurance plans.

Responsibilities

• Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
• Collaborate with field assessors and facility staff via phone to determine if further information is needed on a claimant or member’s health status.
• Call claimants, family members or facility staff to update records on their present health status and provide a new plan of care, as well as handle telephonic assessments.
• Work with new clients to develop processes that meet their insureds’ needs.

Requirements

• RN with a current license residing in a Nursing License Compact state with licensure in their residential state and a Nursing Compact License.
• A minimum of 3 years of professional clinical experience in case management, home care, or a rehabilitation setting, preferably with a geriatric population.
• Strong knowledge of Microsoft applications to include Outlook and Word. Proficient with workflow management tools and CRM.
• Ability to data input into a digital platform while discussing care needs with a claimant or member.
• Ability to handle inbound and outbound calls with claimants, family members, facilities and agencies.
• Excellent communication skills, both oral and written, with a customer service focused attitude to build rapport and relationships.
• Excellent computer, data input and technical skills including working with multiple screens.
• Demonstrate technical and professional expertise through problem resolution, while maintaining composure.
• Strong multi-tasking, time management and follow-up skills to complete tasks in time sensitive manner.
• Ability to independently resolve service issues and follow escalation protocol on issues.
• Make positive impressions over the phone and build rapport with clients, despite conversations that can be difficult or emotion filled.
• Work remotely in a quiet environment with strong, reliable internet while maintaining production levels.

Qualifications

• Bachelor of Science in Nursing (BSN) or equivalent.
• Previous experience with Long Term Care, Medicare, or Medicaid Assessments.
• Telephonic case management experience.
• Bilingual.

Skills

• Excellent communication skills, both oral and written.
• Strong problem-solving and critical thinking abilities.
• Ability to work independently and manage time effectively.
• Proficiency with Microsoft Office Suite and other relevant software.

Benefits

• Competitive compensation and total rewards package.
• Employee benefits including comprehensive healthcare coverage, disability, life, and long-term care insurance, tuition reimbursement, student loan repayment, and training & certification support.
• Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management).
• Caregiver and mental health support services.