Remote RN Clinical Consultant – Disability Claims Expert

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

Job summary

Guardian Life Insurance is seeking an RN Clinical Consultant to serve as a clinical expert supporting short-term and long-term disability claim evaluations. You will analyze medical information, assess functional capacity, and provide guidance to support claim decisions while collaborating with providers and claims professionals.

You will review documentation, estimate recovery timelines, and educate staff on medical implications, ensuring timely, high-quality outcomes for claimants across the

Qualifications

• Active RN license
• 5+ years direct acute patient care
• 3+ years as clinical consultant in LTD/STD (LTD preferred)
• Knowledge of medical conditions and disability duration
• Excellent verbal and written communication
• Clinical assessment and analytical skills
• Independent judgment for clinical decisions
• MS Office proficiency

Responsibilities

• Review short-term and long-term disability claims to evaluate medical documentation, functional limitations, and recovery timelines.
• Analyze impact of illness, injury, and treatment plans on daily living activities and work capacity.
• Collaborate with treating providers, claimants, case managers, and vocational specialists to promote appropriate treatment and return-to-work.
• Educate claims professionals on medical conditions and disability-related outcomes as a clinical SME.
• Coordinate independent medical reviews and ensure timely resolution of complex questions.
• Manage high-volume workload while prioritizing customer needs and quality improvements.
• Mentor and train staff on medical and functional impact on claims.

Skills

Clinical assessment

Analytical thinking

Verbal & written communication

Time management

Independent judgment

Microsoft Office

Education

BSN (preferred)

CCM designation (preferred)

Tools

DCMS

Claim Facts

iProcess

Job description

Guardian Life Insurance is seeking an RN Clinical Consultant to serve as a clinical expert supporting short-term and long-term disability claim evaluations. You will analyze medical information, assess functional capacity, and provide guidance to support claim decisions while collaborating with providers and claims professionals.

You will review documentation, estimate recovery timelines, and educate staff on medical implications, ensuring timely, high-quality outcomes for claimants across the