Clinical Claims Care Coordinator I - A

About the role

illumifin is an insurance technology company and third-party administrator that designs, develops, and delivers tech-enabled insurance policy management software and services, providing unrivaled value for insurers. We combine insurance insight, operational excellence, and technology innovation to build solutions that deliver high performance and position insurers for the digital world. illumifin primarily focuses on the North American life, long-term care, annuity, and health markets. We believe in true partnerships with our customers and are passionate about insurance.

The Clinical Claims Care Coordinator reviews the assessment completed by the field assessor for completeness and accuracy, ensuring it provides the insurance carrier with a clear picture of the policyholder’s current functioning. They also obtain clarifying information from the field assessor and provide guidance on the correct completion of the interview tool. A Clinical Claims Care Coordinator will create a plan of care and be required to review and certify for chronic illness.

Responsibilities

• Review onsite assessments for consistency and quality and collaborate with the field nurse.
• Obtain information from the field assessor to clarify details and provide the carrier with a thorough, high-quality assessment product.
• Prepare professional, objective reports for the insurance customer summarizing information from the assessment using company formats, when appropriate.
• Manage the clinical quality review for completed assessments.
• Act with independent judgment following client and company policies and procedures.
• Complete telephonic and virtual interviews as needed.
• Provide prompt, courteous, and excellent customer service to internal and external customers.
• Demonstrate effective communication skills, attentiveness, and appropriate use of lines of authority.
• Promptly share accurate and complete information with others who need it, based on HIPAA and legal documents regarding release.
• Perform work accurately and demonstrate the ability to prioritize workload.
• Use supplies and other resources (e.g., equipment, computer systems, tools, energy) efficiently and effectively.
• Attend or be responsible for information given at meetings and through other organizational channels.
• Uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook, and related policies and procedures.
• Support and participate in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required.
• Meet established quality and production expectations as communicated by the department.
• Other duties as assigned.