Claims Clinical Specialist - Medical Review Team
About The Position
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care—and we bring those experiences with us to work in serving our millions of policyholders each day. We apply that same compassion and empathy as we work with each other and our local communities, Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism. Our four values guide our strategy, our decisions, and our interactions: Make it human. We care about the people that make up our customers, colleagues, and communities. Make it about others. We do what’s best for our customers and collaborate to drive progress. Make it happen. We work with intention toward a common purpose and forge ways forward together. Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
Requirements
- Active Licensed Social Worker or Registered Nurse
- 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 well as their prognosis and rehabilitative potential.
- Able 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 sound business decisions using risk management and quality protocols.
- Able 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 contracts and Long-Term Care benefits.
- Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.)
Responsibilities
- Identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results.
- Communicate with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy.
- Obtain information about the medical status and care needs of the insured to best understand disease progression, ADL/IADL loss and cognitive status.
- Make decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification.
- Identify, request, and analyze pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery.
- Work within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.
- Communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
Benefits
- Competitive Compensation & Total Rewards Incentives
- Comprehensive Healthcare Coverage
- Multiple 401(k) Savings Plan Options
- Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)
- Generous Paid Time Off – Including 12 Paid Holidays, Volunteer Time Off and Paid 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 & legal management)
- Caregiver and Mental Health Support Services
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
