Claims Clinical Specialist - In-House Certification Specialist

Claims Clinical Specialist – In-House Certification Specialist

Company	Genworth Financial
Location	Kansas, USA, Pennsylvania, USA, North Dakota, USA, Delaware, USA, Washington Metropolitan Area, USA, Iowa, USA, Washington, DC, USA, Vermont, USA, Texas, USA, Lynchburg, VA, USA, Jackson Township, NJ, USA, Florida, USA, Waterbury, CT, USA, South Carolina, USA, Richmond, VA, USA, South Dakota, USA, Georgia, USA, Concord, NH, USA, Mississippi, USA, Tennessee, USA, Virginia, USA, Arkansas, USA, Minnesota, USA, Nebraska, USA, Rhode Island, USA, Kentucky, USA, West Virginia, USA, New York, NY, USA, Maryland, USA, Wisconsin, USA, Maine, USA, Massachusetts, USA, North Carolina, USA, Oklahoma, USA, Missouri, USA, Ohio, USA, Indiana, USA, Louisiana, USA, Michigan, USA, Illinois, USA, Alabama, USA
Salary	$65500 – $116300
Type	Full-Time
Degrees	Bachelor’s
Experience Level	Junior, Mid Level

Active Licensed Social Worker or Registered Nurse
At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential.
Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations.
Demonstrated experience in making sound business decisions using risk management and quality protocols.
Able to manage and prioritize work queues and multiple job responsibilities.
Ability to understand and interpret insurance contracts and Long-Term Care benefits.
Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.).
Ability to toggle between multiple monitors for optimal and efficient productivity
Access to a private, distraction free remote work environment.

Identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results.
Communicate with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy.
Obtain information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss and cognitive status.
Make decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification.
Identify, request, and analyze pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery.
Work within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.
Identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results.
Responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.

No preferred qualifications provided.