Disability Claims Clinical Specialist

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

Job summary

Guardian is seeking a Clinical Specialist with practical nursing experience to support timely disability claim decisions. You will obtain medical documentation, verify treatment plans, and assess functional limitations from claimants and providers, collaborating across teams and vendors to ensure complete information for adjudication.

Qualifications include an active LPN/LVN license, at least two years of clinical or medical office experience, and strong communication skills.

Qualifications

• LPN/LVN license in good standing.
• Minimum two years of clinical or equivalent medical office experience.
• Experience obtaining and reviewing medical documentation from treating providers.
• Excellent written and verbal communication skills.
• Ability to exercise independent and sound judgment in decision-making.

Responsibilities

• Review claim file information and obtain necessary medical documentation (disability certification, treatment plans, functional limitations).
• Identify missing or pertinent information to support disability claim adjudication.
• Document clear and concise details about certification dates, treatment plans, and functional information.
• Collaborate with Claims Case Managers, claimants, and treating providers to facilitate timely outreach and collection of information.
• Coordinate vendor utilization and assist with vendor reports as needed.
• Remain flexible to changing business needs and support team requirements.

Skills

LPN/LVN license

Clinical experience

Medical documentation experience

Strong communication

Independent work

Time management

MS Office / OneNote

Education

LPN or LVN from accredited school

Job description

Guardian is seeking a Clinical Specialist with practical nursing experience to support timely disability claim decisions. You will obtain medical documentation, verify treatment plans, and assess functional limitations from claimants and providers, collaborating across teams and vendors to ensure complete information for adjudication.

Qualifications include an active LPN/LVN license, at least two years of clinical or medical office experience, and strong communication skills.