Clinical Specialist

Guardian Life Insurance Company; Bethlehem (Northampton County); Hybrid; USD 59,000 - 89,000; Full time

Job summary

Guardian Life Insurance Company seeks a Clinical Specialist to leverage nursing experience to support disability claim decisions. You will obtain certification dates, treatment plans, and functional limitations from claimants and providers, collaborating with case managers and vendors to ensure timely information collection.

In this mobile role, you will travel to Guardian offices as needed, prioritize competing demands, and maintain current medical knowledge.

Qualifications

• Licensed Practical or Vocational Nurse (LPN/LVN) with valid license in good standing.
• Experience supporting disability claims or medical case management preferred.
• Excellent written and verbal communication skills.

Responsibilities

• Review claim file information and obtain medical documentation for disability adjudication.
• Identify missing or pertinent information to support decisions.
• Coordinate with Claims Case Managers, claimants and providers for timely outreach.
• Assist with vendor utilization and reporting as needed.

Skills

Clinical knowledge

Communication

Independent worker

Time management

Multitasking

Microsoft Office

OneNote

Education

LPN or LVN license

Tools

Microsoft Office

OneNote

Job description

Job Description – Clinical SpecialistPosition SummaryAs 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 areYou 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 havePreferred Qualifications:Experience supporting disability claims, medical case management, or a related insurance functionExperience obtaining and reviewing medical documentation from treating providersLPN or LVN from an accredited school of nursing with a valid license in good standingMinimum of two years of clinical experience or equivalent medical office experienceExcellent written and verbal communication skillsAbility to exercise independent and sound judgment in decision-makingExcellent time-management, organizational, prioritization, and multitasking skillsSelf-motivated and able to work independently and collaboratively with multiple professional disciplines and diverse populationsCurrent medical knowledge maintained through continuing educationBasic computer proficiency, including Microsoft Office and OneNoteYou willReview claim file information and obtain necessary medical documentation, including disability certification, treatment plans, functional limitations, and restrictions from treating providersUse medical knowledge to identify missing or pertinent information needed to support disability claim adjudicationDocument clear and concise details regarding certification dates, treatment plans, functional information, and other relevant claim informationCollaborate with Claims Case Managers, claimants, and treating providers to facilitate timely outreach and collection of medical informationSupport vendor management by coordinating services, scheduling, following up on vendor reports, and assisting with vendor utilization as neededRemain flexible to changing business needs and assist the team in meeting customer and departmental requirementsReporting RelationshipsAs our Clinical Specialist, you will report to the Clinical Specialist Team Leader, who reports to the Head of Disability Clinical and Vocational Organization.LocationThis 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 - $88,660.00The 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 PromiseAt 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-BeingAs 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 OpportunityGuardian 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.AccommodationsGuardian 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 SponsorshipGuardian 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 RecruitmentAs 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). 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.Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to [e-mail], making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via [e-mail], at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here.Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.