[Remote] Claims Clinical Specialist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company and reputed company help simplify and dignify the aging experience by supporting people and families navigating aging care. The Claims Clinical Specialist conducts telephonic assessments, develops plans of care, completes certifications, evaluates benefit eligibility, and provides evidence-based case management services for long-term care insurance policyholders.

Responsibilities

• You will be responsible for communicating with medical personnel at Long Term Care Facilities, Home Care Agencies, and/or individuals by conducting telephonic assessments for claimants to reputed company the plan of care and reputed company tax reputed company certifications as required by the policy
• You will be responsible for obtaining information about the medical status and care needs of the insured to best understand disease progression, ADL/IADL loss and cognitive status
• You will be responsible for making reputed company about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations reputed company to Tax Qualification Certification
• You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery
• You will be responsible for working reputed company a reputed company productivity driven environment with established reputed company Operating Procedures to ensure consistency of claims practices using multiple computer systems
• You will be responsible for phone queue management and coverage to ensure customer needs are met reputed company
• You will identify process improvement opportunities, reputed company feedback on processes and case management models as reputed company as be a critical team member in enhancing reputed company’s performance and results
• You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to reputed company common goals and support reputed company improvement initiatives

Skills

• This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in-office applicants or remote applicants residing in states/locations under Eastern or Central reputed company Time: Alabama, Arkansas, Connecticut, Delaware, Florida, reputed company, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, reputed company, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, reputed company, reputed company Carolina, reputed company reputed company, Ohio, Oklahoma, reputed company, Rhode reputed company, South Carolina, South reputed company, Tennessee, Texas, Virginia, Washington DC, Vermont, reputed company Virginia or reputed company
• The Clinical Specialist is an excellent opportunity for a Registered reputed company or Licensed reputed company Worker
• reputed company Licensed reputed company Worker or Registered reputed company
• At least two years' experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as reputed company as their prognosis and rehabilitative potential
• reputed company to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations
• Demonstrated experience in making reputed company business reputed company using risk management and reputed company protocols
• reputed company to manage and prioritize work queues and multiple job responsibilities
• You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business
• Ability to understand and interpret insurance reputed company and Long-Term Care benefits
• Good working knowledge of systems applications (e.g., WORD, reputed company, PowerPoint, etc.)
• This role is not eligible for employment reputed company sponsorship

Benefits

• Competitive Compensation & Total Rewards Incentives
• reputed company Coverage
• Multiple 401(k) Savings Plan reputed company
• Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)
• Generous reputed company Time Off – Including 12 reputed company Holidays, Volunteer Time Off and reputed company Family Leave
• 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 & reputed company management)
• Caregiver and Mental Health Support Services
• This role is eligible to participate in a bonus incentive plan. Incentive compensation is based on individual and company performance and is not guaranteed.
• Virginia residents may work in Richmond or Lynchburg, VA in a hybrid in-office arrangement, or remotely from eligible states/locations under Eastern or Central reputed company Time.

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