Associate Claims Clinical Specialist

About the role

The Associate Claims Clinical Specialist position at CareScout plays a leading role in the insured or member's assessment process. We provide services to a variety of clients requiring deep knowledge of long-term care needs for an aging or chronically ill population. You will be part of a remote team of clinicians who 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. Some days involve reaching out to claimants or members, their families, or facilities to discuss updates to their health and develop a plan of care.

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.
• Able to data input into a digital platform while discussing care needs with a claimant or member.
• Able 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.
• Able to meet daily tracked standards in both production and quality. 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.
• Able to independently resolve service issues and follow escalation protocol on issues.
• Able to make positive impressions over the phone and build rapport with clients, despite conversations that can be difficult or emotion-filled.
• Able to 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 (optional but preferred).

Skills

• Critical thinking capabilities, coupled with the ability for independent decision-making.
• Technical and professional expertise through problem resolution, while maintaining composure.

Benefits

• Competitive Compensation & Total Rewards
• Incentive compensation based on individual and company performance.
• Employee Benefits & Well-Being