Claims Clinical Specialist

Genworth Financial, Inc.; United States; Hybrid; USD 69,000 - 103,000; Full time

Benefits offered by this job

Healthcare Coverage

401(k) Savings Plan

Paid Time Off

Employer Retirement Match

Disability & Life Insurance

Tuition Reimbursement

Wellness & EAP Support

Caregiver Support

Job summary

Genworth Financial, Inc. is seeking a Claims Clinical Specialist in Virginia with RN or LSW credentials. You will deliver evidence-based short-term case management to long-term care policyholders, perform telephonic assessments, and update care plans while coordinating with long-term care facilities and home care agencies.

This role emphasizes quality, risk management, and regulatory compliance. You will work in a hybrid in-office/remote setup with opportunities to impact certification processes

Qualifications

• Active Licensed Social Worker or Registered Nurse.
• At least two years’ experience handling complex aging health conditions and prognosis.
• Ability to interpret MDS, Plan of Care, physician records and disease progression.
• Experience applying risk management and quality protocols.
• Strong time management and prioritization in a production setting.
• Reliable attendance to support business needs.

Responsibilities

• Identify process improvements and provide feedback to enhance case management models.
• Communicate with medical personnel to conduct telephonic assessments and develop care plans.
• Assess medical status and care needs of insured clients to understand disease progression.
• Decide on care expectations and benefit eligibility per policy and HIPAA rules.
• Request and analyze medical records to inform disease progression and recovery potential.
• Operate in a productivity-driven environment using multiple computer systems.
• Manage phone queues to ensure timely customer service.
• Collaborate with other teams to support continuous improvement.

Skills

Licensed Social Worker

Registered Nurse

MDS interpretation

Care plan assessment

Clinical risk management

Multitasking

Decision making

Tools

Microsoft Word

Excel

PowerPoint

Job description

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.

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

• 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.

Genworth Financial, Inc (“Genworth”) (NYSE: GNW)

Genworth Financial, Inc (“Genworth”) (NYSE: GNW) is a Fortune 1000 company focused on empowering families to navigate the aging journey with confidence, now and in the future. Headquartered in Richmond, Virginia, Genworth and its CareScout businesses provide guidance, products, and services that help people understand their caregiving options and fund their long-term care needs. Genworth is also the parent company and majority-owner of publicly traded Enact Holdings, Inc. (Nasdaq: ACT), a leading U.S. mortgage insurance provider.

Genworth Mexico Genworth US

We know we can’t deliver on our mission unless we deliver for our employees. That’s why we’re committed to creating a work environment that fosters inclusion, excellence, improvement and connection. We know each employee contributes in their own unique way and we’re dedicated to supporting every one of them to help them reach their full potential.

Equal Opportunity Statement

We are proud to be an equal opportunity employer and all hiring decisions are based on merit, qualifications, and business need.

We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.