Associate Claims Clinical Specialist

Responsibilities

• Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
• Collaborate with field assessors and facility staff via phone to determine if further information is needed on a claimant or member’s health status.
• Call claimants, family members or facility staff to update records on their present health status and provide a new plan of care, as well as handle telephonic assessments.
• Work with new clients to develop processes that meet their insureds’ needs.

Requirements

• RN with a current license residing in a Nursing License Compact state with licensure in their residential state and a Nursing Compact License
• A minimum of 3 years of professional clinical experience in case management, home care, or a rehabilitation setting, preferably with a geriatric population
• Strong knowledge of Microsoft applications to include Outlook and Word.
• Proficient with workflow management tools and CRM
• Ability to handle inbound and outbound calls with claimants, family members, facilities and agencies
• Excellent computer, data input and technical skills including working with multiple screens.
• Bilingual is nice to have