Senior Clinical Consultant (Remote)

About the role

The Senior Clinical Consultant will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and will serve as clinical subject matter expert in all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems.

Responsibilities

• Provide ongoing training, coaching and development to all Clinical Consultant members
• Organize and present at least one Clinical Training session for the Claims teams over the course of a year
• Work with Team Manager to delegate, distribute, and monitor workloads within the department to meet departmental regulations, improve efficiency and reduce or eliminate backlogs
• Avoid and resolve issues that come up related to clinical processes, claim management activities, customer inquiries, and quality
• Train and mentor all new Clinical Consultants
• Assist the Clinical Team Manager in managing and resolving issues that come up related to clinical processes, claim management activities, customer inquiries, and quality
• Oversee external vendor utilization within team
• Leverage knowledge and skills to flex and assist the overall team meet its goals, (i.e., assist with STD/LTD/ Appeals, flex and assist if needed)
• Collaborate with claims partners to resolve conflicts and establish procedures that promote clinical claim management accuracy and improved customer service
• Address escalated customer inquiries and formal complaints
• Support training initiatives by identifying knowledge gaps and providing ideas for improvement
• Support Clinicians in developing efficient desk & time management skills
• Co-facilitate team meetings to share best practices, workflow changes, trends, and insights in alignment with Group benefits strategies
• Provide desk coverage for leadership as needed

Requirements

• A minimum of 5 years of (STD, LTD, Appeals) claim experience, minimum of 2 years disability experience
• A minimum of 5 years in direct patient care settings
• BSN and CCM preferred

Qualifications

• Excellent verbal and written communication skills and presentation skills
• Strong problem-solving, analytical, clinical, and information research skills
• Excellent time management & organizational skills
• Demonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulations
• The ability to remain flexible due to changing business needs
• Proven ability to mentor and coach
• Proficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcess

Skills

• Highly motivated and reliable individual who can work with varying levels of supervision – independently or collaboratively
• Detail-oriented and a decisive decision maker who can manage multiple priorities at the same time with a positive attitude
• Exercise independent & sound judgment in decision making
• Ability to remain flexible due to changing business needs
• Proven ability to mentor and coach
• Ability to exercise independent & sound judgment in decision making

Benefits

Not specified

Pay

$68,970.00 - $113,310.00

Schedule

Flexible – work primarily from home. May be expected to come into a Guardian work location occasionally, as determined by their people leader. Travel Occasional 0-10% of the time.