Clinical Specialist

Guardian Life; Bethlehem (Northampton County); Teletrabalho; USD 59 000 - 89 000; Tempo integral

Resumo da oferta

Guardian Life is seeking a Clinical Specialist to support timely disability claim decisions by collecting and reviewing medical information from claimants and treating providers. You will identify gaps, document relevant certifications and treatment plans, and collaborate with claims teams, claimants, providers, and vendors to ensure efficient medical outreach.

You are an licensed Practical or Vocational Nurse (LPN/LVN) with strong clinical judgment, excellent communication, and the ability to

Qualificações

• Experience supporting disability claims or medical case management.
• Experience obtaining and reviewing medical documentation from treating providers.
• Ability to exercise independent and sound judgment in decision-making.
• Excellent written and verbal communication skills.
• Proficiency with Microsoft Office and OneNote.

Responsabilidades

• Review claim file information and obtain necessary medical documentation from treating providers.
• Identify missing or pertinent information to support disability claim adjudication.
• Document dates, treatment plans, functional information, and other claim details clearly.
• Collaborate with Claims Case Managers, claimants, and providers to facilitate outreach and collection of medical information.
• Coordinate vendor services, scheduling, and follow-up on reports as needed.
• Support the team in adapting to changing business needs.

Conhecimentos

Disability claims knowledge

Medical documentation review

Independent judgment

Excellent communication

MS Office / OneNote proficiency

Formação académica

LPN or LVN license

Descrição da oferta de emprego

Fully Remote

Bethlehem

Full time

R000110371

Job Description – Clinical Specialist

Position Summary

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.

You are

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

You have

Preferred Qualifications:

• Experience supporting disability claims, medical case management, or a related insurance function

• Experience obtaining and reviewing medical documentation from treating providers

• 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

You will

• 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

Reporting Relationships

As our Clinical Specialist, you will report to the Clinical Specialist Team Leader, who reports to the Head of Disability Clinical and Vocational Organization.

Location

This is a mobile position where preference may be given to candidates within commuting proximity to a Guardian office with the ability to travel to Guardian offices as determined by the People Leader.

Salary Range:

$59,110.00 - $88,660.00

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 . Benefits apply to full-time eligible employees. Interns are not eligible for most Company 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] . Please note: this resource is for accommodation requests only. For all other inquires related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (“AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers (http://%20https://www.guardianlife.com/careers) ). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues.

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 .

Visa Sponsorship:

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.