Clinical Specialist

Guardian Life Insurance; United States; Hybrid; USD 59,000 - 89,000; Full time

Job summary

Guardian Life Insurance is seeking a Clinical Specialist to support disability claim decisions using nursing expertise. You will gather medical information, document functional limitations, and collaborate with claimants, treating providers, and vendors to ensure timely information collection.

The role emphasizes independent judgment, strong communication, and ongoing medical knowledge, with a mobile travel component to potentially travel between Guardian offices.

Qualifications

• Experience supporting disability claims or medical case management.
• Experience obtaining and reviewing medical documentation from treating providers.
• LPN or LVN license in good standing with an accredited program.

Responsibilities

• Review claim file information and obtain necessary medical documentation.
• Identify missing or pertinent information to support adjudication.
• Document certification dates, treatment plans, functional limitations, and other claim details.
• Collaborate with Claims Case Managers, claimants, providers, and vendors for timely medical information outreach.
• Coordinate vendor services and assist with vendor utilization.
• Adapt to changing business needs and support team requirements.

Skills

Disability claims

Medical documentation

LPN/LVN license

Clinical experience

Communication skills

Independent judgment

Time management

Collaboration across disciplines

Continuing education

MS Office & OneNote

Education

LPN/LVN license from accredited school

Tools

Microsoft Office

OneNote

Job description

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). 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].

Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here.