Claims Clinical Specialist
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What you'll do
- Identify process improvement opportunities, provide feedback on processes and case management models 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, Home Care Agencies, and/or individuals 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 productivity driven environment with established Standard Operating Procedures to ensure consistency of claims practices using multiple computer systems.
- Phone queue management and coverage to ensure customer needs are met timely.
- Communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
What they're looking for
- 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.
- 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.).
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
At Genworth and CareScout, we're on a mission to simplify and dignify the aging experience.
The truth is, most of us will help a parent, spouse, family member, friend, or neighbor navigate aging and care at some point in our lives. We've been there ourselves. That's why we're building better ways to help people find, fund, and understand aging care all while being supported every step of the way.
We're a team of curious problem-solvers, compassionate listeners, and people who care about making a difference. We value diverse perspectives and are committed to fostering an inclusive culture where every team member feels respected, supported, and empowered to bring their authentic self.
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.
If you’re looking to build a meaningful career while helping transform the aging experience for millions of families, we’d love to hear from you.
POSITION TITLE
Claims Clinical Specialist
POSITION LOCATION
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 Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin.
YOUR ROLE
As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders – now and in the future.
The Clinical Specialist is an excellent opportunity for a Registered Nurse or Licensed Social Worker. Bring your clinical knowledge and experience, and Genworth will provide the training necessary to succeed in this role. You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing telephonic assessments, and monitoring claimants with multiple health conditions. This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.
What You Will Be Doing
You will identify process improvement opportunities, provide feedback on processes and case management models as well as be a critical team member in enhancing the team’s performance and results.
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 develop the plan of care and provide tax qualified 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 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.
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 within a structured productivity driven environment with established Standard 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 timely.
You will identify process improvement opportunities, provide feedback on processes and case management models as well as be a critical team member in enhancing the team’s performance and results.
You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
What You Bring
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.).
Employee Benefits & Well-Being
Genworth employees make a difference in people’s lives every day. We’re committed to making a difference in our employees’ lives.
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
COMPENSATION
National Range: 68,900 - 103,000
High-Cost Range (including New York): 86,100 - 129,000
Disclaimer: This role is aligned to a national market-based pay range. Actual compensation will vary based on geographic location, experience, skills, and other job-related factors. In addition to base salary, this role is eligible to participate in a bonus incentive plan. Incentive compensation is based on individual and company performance and is not guaranteed.
ADDITIONAL / OPTIONAL
This role is not eligible for employment visa sponsorship.
Company
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