Associate Claims Clinical Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Assessing clinical evaluations conducted by field assessors to ascertain chronic illness status and formulate a care plan along with necessary written documentation.

• Collaborate with field assessors and facility personnel via phone to identify if additional information is required regarding a claimant or member’s health condition.

• Contact claimants, family members, or facility staff to refresh records on their current health status, provide an updated care plan, and conduct telephonic assessments.

• Partner with new clients to establish procedures that cater to their insureds’ requirements.

⛳️ Requirements

• RN with an active license residing in a Nursing License Compact state, holding licensure in their home state and a Nursing Compact License.

• At least 3 years of professional clinical experience in case management, home care, or rehabilitation settings, ideally with a geriatric demographic.

• Proficient in Microsoft applications including Outlook and Word.

• Skilled in using workflow management tools and CRM systems.

• Capable of data entry into a digital platform while discussing care requirements with a claimant or member.

• Experience in managing inbound and outbound calls with claimants, family members, facilities, and agencies.

• Exceptional communication abilities, both verbal and written, with a customer service-oriented mindset to foster rapport and relationships.

• Capacity to meet daily performance metrics in both productivity and quality.

• Strong computer skills, data entry proficiency, and technical abilities, including multitasking across multiple screens.

• Ability to showcase technical and professional knowledge through effective problem-solving while maintaining composure.

• Competence in engaging with both internal and external clients at all levels.

• Robust critical thinking skills paired with independent decision-making capabilities.

• Demonstrated ability to manage multiple tasks, time effectively, and follow up to ensure timely completion of responsibilities.

• Proficient in independently addressing service challenges and adhering to escalation protocols when necessary.

• Skilled at creating positive impressions over the phone and establishing rapport with clients, even during challenging or emotionally charged conversations.

• Capacity to work remotely in a quiet environment with a reliable internet connection while maintaining productivity levels.

🏝️ Benefits

• Competitive Compensation & Total Rewards Incentives.

• Comprehensive Healthcare Coverage.

• Multiple 401(k) Savings Plan Options.

• Automatic Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!).

• Generous Paid Time Off – Including 12 Paid Holidays, Volunteer Time Off, and Paid Family Leave.

• Disability, Life, and Long-Term Care Insurance.

• Tuition Reimbursement, Student Loan Repayment, and Training & Certification Support.

• Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management).

• Caregiver and Mental Health Support Services.