[Hiring] Clinical Specialist @Guardian Life Insurance

Role Description

As a Clinical Specialist, you will use your practical or vocational nursing experience and knowledge of medical and behavioral health conditions to support timely disability claim decisions. You will:

• Identify and obtain certification dates, treatment plans, functional limitations, and other pertinent medical information from claimants and treating providers.
• Partner with Claims Case Managers, claimants, providers, and vendors to facilitate efficient medical outreach and collection of information.
• Coordinate vendor utilization and help assess overall function as business needs require.

Qualifications

• Experience supporting disability claims, medical case management, or a related insurance function.
• Experience obtaining and reviewing medical documentation from treating providers.
• LPN or LVN from an accredited school of nursing with a valid license in good standing.
• Minimum of two years of clinical experience or equivalent medical office experience.
• Excellent written and verbal communication skills.
• Ability to exercise independent and sound judgment in decision-making.
• Excellent time-management, organizational, prioritization, and multitasking skills.
• Self-motivated and able to work independently and collaboratively with multiple professional disciplines and diverse populations.
• Current medical knowledge maintained through continuing education.
• Basic computer proficiency, including Microsoft Office and OneNote.

Requirements

• Review claim file information and obtain necessary medical documentation, including disability certification, treatment plans, functional limitations, and restrictions from treating providers.
• Use medical knowledge to identify missing or pertinent information needed to support disability claim adjudication.
• Document clear and concise details regarding certification dates, treatment plans, functional information, and other relevant claim information.
• Collaborate with Claims Case Managers, claimants, and treating providers to facilitate timely outreach and collection of medical information.
• Support vendor management by coordinating services, scheduling, following up on vendor reports, and assisting with vendor utilization as needed.
• Remain flexible to changing business needs and assist the team in meeting customer and departmental requirements.

Benefits

• Support and flexibility to achieve your professional and personal goals.
• Opportunities for skill-building, leadership development, and philanthropic activities.
• Contemporary, supportive, flexible, and inclusive benefits and resources.