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Healthcare Claims Consultant
2 months ago
Guardian Life Insurance Company is seeking a Medical Specialist who possesses a comprehensive understanding of various medical and behavioral health issues. This role involves conducting essential outreach to claimants and healthcare providers to gather certification dates, treatment plans, and other critical medical data necessary for assisting claims managers in making informed disability claims decisions. The ideal candidate will utilize their medical expertise to identify required medical information and execute the necessary actions to secure this information. Additionally, this position may involve coordinating and supervising vendor utilization and contributing to the overall operational efficiency required for prompt claim resolutions.
Key Responsibilities:
- Evaluate case files, procure necessary medical documentation, and secure disability certifications from healthcare professionals.
- Support Vendor Management initiatives.
- Maintain accurate and detailed records regarding certification dates, treatment plans, and other relevant claim information.
- Collaborate with Claims Case Managers and claimants to ensure timely outreach to physicians and the collection of medical data.
- Adapt to evolving business requirements and assist the team as needed to fulfill customer needs.
Qualifications:
- Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) from an accredited nursing program with a valid license in good standing.
- A minimum of 2 years of clinical experience or equivalent experience in a medical office setting.
- Exceptional written and verbal communication abilities.
- Capacity to exercise independent judgment and sound decision-making.
- Experience in vendor management, working collaboratively with vendors to schedule and follow up on reports.
- Strong time management and organizational skills.
- Adept at multitasking and managing shifting priorities based on customer service demands and departmental guidelines.
- Self-driven and capable of working independently.
- Ability to collaborate effectively with diverse professional disciplines and populations.
- Current knowledge of medical conditions and treatments maintained through ongoing education.
- Basic proficiency in computer skills, including Microsoft Office.
Leadership Attributes:
- Consistently aims to deliver exceptional products and customer service.
- Communicates openly and honestly.
- Demonstrates self-awareness and welcomes constructive feedback.
Work Environment:
This position offers flexibility and the option to work remotely. Occasional in-office presence may be required as determined by management.
Compensation:
The salary range for this position is $48,000 to $72,280. The final salary will be based on the candidate's education, experience, knowledge, and skills. This role may also be eligible for additional compensation based on performance.
Commitment to Employee Well-Being:
At Guardian, we are dedicated to supporting your professional and personal aspirations. We offer opportunities for skill development, leadership training, and community engagement, fostering a diverse workplace with high ethical standards.
Benefits Overview:
Guardian provides a comprehensive benefits package, including health care options, life and disability insurance, retirement plans, and generous time-off policies. We prioritize emotional well-being and work-life balance, offering resources and programs to support our employees.
Equal Opportunity Employer:
Guardian is an equal opportunity employer, welcoming applicants from all backgrounds and experiences. We are committed to providing reasonable accommodations for individuals with disabilities throughout the employment process.
