Senior Clinical Consultant, Disability Appeals

Guardian Life Insurance Company; United States; Remote; USD 67,000 - 111,000; Full time

Job summary

A leading insurance company seeks a Senior RN Clinical Consultant to join their team. This remote role involves providing oversight, mentoring, and managing Clinical Consultants to enhance service delivery in disability claims. The incumbent will work closely with leadership to drive performance and ensure organizational excellence.

Qualifications

• A minimum of 3+ years of claims experience.
• At least 5 years in direct patient care settings.
• Demonstrated proficiency in communication skills.

Responsibilities

• Train and mentor all new Clinical Consultants.
• Assist in monitoring caseloads and productivity.
• Collaborate with claims partners for accurate claim management.

Skills

Leadership

Problem-solving

Analysis

Communication

Organizational

Judgment

Education

RN

BSN

CCM

Tools

MS Word

Excel

PowerPoint

DCMS

Claim Facts

iProcess

Job description

The Senior RN Clinical Consultant will work in partnership with Clinical and Vocational Leaders to provide ongoing coaching and oversight to Clinical Consultants and will serve as clinical subject matter expert in all lines of business (STD/LTD/Appeals) and products, action planning management, and Guardian systems. This incumbent will have a strong clinical and client focus to assist in ensuring the fair and accurate assessments of medically supported functional abilities. They will assist in cultivating talent and foster an environment of continuous learning. They will promote organizational excellence by demonstrating leadership, problem-solving behaviors, and viewing challenges as opportunities. This individual will work with the Clinical Team Manager to drive performance and ensure the team meets their goals. They will effectively communicate & explain departmental initiatives and changes as they relate to organizational goals & strategies. They will assist the Clinical Team Manager in managing and resolving issues that come up related to clinical processes, claim management activities, customer inquiries, and quality.

You are

A highly motivated and reliable individual who can work with varying levels of supervision – independently or collaboratively. You are diligent and a decisive decision maker who can prioritize multiple tasks simultaneously with a positive attitude.

You have

• A minimum of 3+ years of (STD, LTD, Appeals) claim experience, minimum of 2 years disability experience
• A minimum of 5 years in direct patient care settings
• RN REQUIRED, BSN and CCM preferred
• Demonstrated proficiency in verbal and written communication, as well as strong presentation abilities
• Ability to exercise independent & sound judgment in decision making
• Strong problem-solving, analytical, clinical, and information research skills
• Excellent time management & organizational skills
• Demonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulations
• The ability to remain flexible due to changing business needs
• Proven track record to mentor and coach
• Proficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcess

You will

• Train and mentor, all new Clinical Consultants
• Provide ongoing training, coaching and development to all Clinical Consultant members
• Organize and present at least one Clinical Training session for the Claims teams over the course of a year
• Work with Team Manager to delegate, distribute, and monitor workloads within the department to meet departmental regulations, improve efficiency and reduce or eliminate backlogs
• Assist Team Manager when needed to monitor caseloads, productivity, and participate in calibration sessions with our Clinical CMA and provide feedback to leadership and team members
• Oversee external vendor utilization within team
• Leverage knowledge and skills to flex and assist the overall team meet its goals, (i.e., assist with STD/LTD/ Appeals, flex and assist if needed)
• Collaborate with claims partners to resolve conflicts and establish procedures that promote clinical claim management accuracy and improved customer service
• Address escalated customer inquiries and formal complaints. Senior BHCM will also be first point of contact for SI or mental health crisis calls
• Support training initiatives by identifying knowledge gaps and providing ideas for improvement
• Support Clinicians in developing efficient desk & time management skills
• Collaborate with peers and leadership to ensure consistency with mentoring and coaching
• Co-facilitate team meetings to share best practices, workflow changes, trends, and insights in alignment with Group benefits strategies
• Provide desk coverage for leadership as needed

Location
This is a remote position with occasional travel as needed for department meetings determined by the people leader.

Salary Range:

$67,450.00 - $110,815.00

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] .

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.