Clinical Specialist

Guardian Life Insurance•Bethlehem, PA

8d•$59,110 - $88,660•Remote

About The Position

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. You will partner with Claims Case Managers, claimants, providers, and vendors to facilitate efficient medical outreach and collection of information. You may also coordinate vendor utilization and help assess overall function as business needs require.

Requirements

Licensed Practical or Vocational Nurse who applies sound clinical judgment, communicates clearly, and works independently in a fast-paced environment.
Organized, adaptable, and comfortable managing changing priorities while collaborating with claim professionals, claimants, treating providers, vendors, and multiple professional disciplines.
Committed to maintaining current medical knowledge, delivering responsive customer service, and documenting accurate, concise information that supports timely claim decisions.
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

Nice To Haves

Experience supporting disability claims, medical case management, or a related insurance function
Experience obtaining and reviewing medical documentation from treating providers

Responsibilities

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