Senior Clinical Consultant, Disability Appeals
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Bethlehem, PA, US
Company:
Guardian is a leading mutual insurance company dedicated to inspiring well-being through a range of insurance and financial products.
Summary:
The Senior Clinical Consultant will provide oversight and coaching to Clinical Consultants while serving as a subject matter expert in various claims management processes. Candidates need 3+ years of claims experience, 5 years in patient care, an RN license, and strong clinical and communication skills.
Requirements:
Credentials: RN REQUIRED, BSN and CCM preferred
Experience: A minimum of 3+ years of (STD, LTD, Appeals) claim experience, A minimum of 5 years in direct patient care settings
Job Description:
The Senior 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.
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.
- 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 training sessions, monitor workloads within the team, oversee external vendor utilization, collaborate with claims partners, address escalated customer inquiries, support training initiatives, co-facilitate team meetings, and 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.
