Behavioral Health Clinical Consultant, Disability Claims

Guardian Life; Tallahassee (FL); Remote; USD 67,000 - 111,000; Full time

Job summary

A leading insurance provider is seeking a professional to review disability claims, focusing on the medical aspects affecting claimants' functions. This role involves collaboration with healthcare providers and educating claim staff, requiring strong communication and analytical skills along with a BSN or equivalent. The position allows for remote work with potential travel for meetings.

Benefits

Flexible work arrangements

Career development opportunities

Diverse and inclusive workplace benefits

Qualifications

• Minimum of 5 years in direct patient care settings.
• Strong knowledge of medical conditions and their application to disability products.
• Experience with disability claims preferred.

Responsibilities

• Review disability claims to assess medical impact on functionality.
• Collaborate with healthcare providers and claimants to promote treatment accountability.
• Educate claim staff on medical aspects of disability.

Skills

Excellent verbal and written communication skills

Analytical and problem-solving skills

Strong organizational skills

Ability to multitask

Knowledge of medical conditions

Education

BSN or related behavioral health degree

Tools

Microsoft Office applications (MS Word, Excel, PowerPoint)

DCMS, Claim Facts, and iProcess

Job description

You are

• A highly motivated and reliable individual who can work with varying levels of supervision- independently or collaboratively.

• Detail-oriented and a decisive decision maker who can manage multiple priorities at the same time.

• Able to identify opportunities to educate claim staff and peers on medical aspect of disability.

• Able to understand and apply clinical rationale of how injury or illness may impact the individual’s function.

You will

• Review long-term and or short-term disability claims to assess the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes.

• Possess excellent verbal and written communication skills to gather and report information accurately, ask appropriate questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation of claimant in appropriate treatment goals.

• Conduct analysis of claimant’s current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability.

• Proactively contact treating providers to discuss treatment plans and clarify treatment and RTW goals. Educate providers and claimants on the positive impact of return to work to ensure improved functional status and medical outcomes.

• Serve as a technical resource on the medical aspect of long-term and or short-term disability claims.

• Provide ongoing training and mentoring to claims staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.

• Work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work.

• Work to proactively identify and resolve customer issues, when possible, to enhance the customer experience.

• Utilize independent vendors to perform independent medical assessments. Specifically define issues to be addressed or clarified by outside physician or provider and oversee quality of review.

You have

• A minimum of 5 years in direct patient care settings

• BSN with strong Behavioral Health background preferred. Will consider LCSW or other licensed Behavioral Health professional with disability claims experience.

• Excellent verbal and written communication skills and presentation skills

• Ability to exercise independent & sound judgment in decision making

• Strong problem-solving, analytical, clinical, and information research skills

• Excellent time management & organizational skills

• Demonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulations

• The ability to remain flexible due to changing business needs

• Strong knowledge of medical conditions and how they apply to disability products

• Professional oral, written and presentation skills

• Strong PC skills, including Microsoft Office applications (MS Word, Excel, PowerPoint)

• Knowledge of disability products, business rules and procedures, preferred

• Experience with DCMS, Claim Facts, and iProcess preferred

• Disability experience strongly preferred

Location

• This is a remote role with possible travel for leadership meetings.

Salary Range:

$67,450.00 - $110,815.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits .

Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual\'s known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [e-mail] .

Current Guardian Colleagues

Please apply through the internal Jobs Hub in Workday.

Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com.