Remote RN Clinical Consultant: Disability Claims Expert

Guardian Life Insurance Company; United States; Remote; USD 69,000 - 113,000; Full time

Job summary

Guardian Life Insurance Company seeks an experienced RN Clinical Consultant to evaluate short- and long-term disability claims, analyze medical information, assess functional capacity, and support claim decisions. You will collaborate with providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans and return-to-work opportunities.

The role involves coordinating independent medical reviews, educating staff on medical conditions, and

Qualifications

• Active Registered Nurse (RN) license required.
• Minimum of 5 years of direct acute patient care experience.
• Minimum of 3 years' experience as a clinical consultant in LTD/STD (LTD preferred).
• Strong knowledge of medical conditions, treatments, and their impact on functional capacity and disability duration.
• Excellent verbal and written communication skills.
• Strong clinical assessment, analytical, critical thinking, and research skills.
• Ability to exercise independent judgment and make sound clinical decisions.
• Strong organizational and time-management skills with the ability to prioritize competing demands.
• Proficiency with Microsoft Office applications (Word, Excel, PowerPoint).
• Ability to adapt to changing business needs and a dynamic environment.

Responsibilities

• Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, treatment progress, and expected recovery timelines.
• Analyze the impact of illness, injury, and treatment plans on a claimant’s ability to perform occupational and daily living activities, providing clinical recommendations to support claim decisions.
• Collaborate with treating providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans and facilitate return-to-work opportunities.
• Serve as a clinical subject matter expert by educating claims professionals on medical conditions, treatment interventions, and disability-related outcomes.
• Coordinate independent medical reviews and assessments, ensuring quality, accuracy, and timely resolution of complex clinical questions.
• Manage a high-volume workload while prioritizing customer needs and supporting continuous quality improvement initiatives.
• Provide ongoing mentoring and training to claims staff regarding the medical and functional impact of injury, illness, and treatment on disability claims.

Skills

RN License

Acute care experience

Clinical consulting LTD/STD

Medical knowledge

Verbal & written communication

Analytical thinking

Independent judgment

Time management

MS Office

Adaptability

Education

BSN

CCM designation

Tools

DCMS

Claim Facts

iProcess

Job description

Guardian Life Insurance Company seeks an experienced RN Clinical Consultant to evaluate short- and long-term disability claims, analyze medical information, assess functional capacity, and support claim decisions. You will collaborate with providers, claimants, case managers, and vocational rehabilitation specialists to promote appropriate treatment plans and return-to-work opportunities.

The role involves coordinating independent medical reviews, educating staff on medical conditions, and