Healthcare Claims Specialist
2 weeks ago
Guardian Life Insurance Company presents an exciting opportunity for a Medical Specialist. In this role, you will possess expertise in various medical and behavioral health issues. Your primary responsibility will be to conduct outreach to claimants or healthcare providers to gather essential certification dates, treatment plans, and other relevant medical details necessary for assisting claims managers in making informed disability claims decisions. Utilizing your medical knowledge, you will identify the required medical information and execute the necessary steps to obtain it. Additionally, you may assist in coordinating vendor utilization and evaluating overall functionality to ensure prompt claim resolutions.
Your Responsibilities:
- Examine case files, procure necessary medical information, and secure disability certifications and limitations from healthcare providers.
- Support Vendor Management initiatives.
- Document precise and clear details regarding certification dates, treatment plans, and other relevant claim information.
- Collaborate with Claims Case Managers and claimants to ensure timely outreach to physicians and collection of medical data.
- Adapt to evolving business requirements and assist the team in meeting customer needs.
Qualifications:
- Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) from an accredited nursing program with a valid license in good standing.
- At least 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, collaborating effectively with vendors for scheduling and follow-up on reports.
- Strong time management and organizational skills.
- Adept at multitasking and managing shifting priorities based on customer service needs and departmental guidelines.
- Self-driven and capable of working independently.
- Ability to work collaboratively across various professional disciplines and with diverse populations.
- Current knowledge of medical conditions and treatments maintained through ongoing education.
- Basic computer proficiency, including familiarity with Microsoft Office.
Leadership Attributes:
- Consistently aims to deliver superior products and customer service.
- Communicates openly and honestly.
- Demonstrates self-awareness and welcomes constructive feedback.
Location:
This position offers flexibility with remote work options. Occasional in-office presence may be required as determined by leadership.
Compensation:
The salary range for this position is $48,000 to $72,280. This range is a good faith estimate of base pay for the primary location of the role. The final salary will be determined based on the candidate's education, experience, knowledge, and abilities.
Our Commitment:
At Guardian, we provide the support and flexibility necessary for you to achieve your professional and personal aspirations. Through skill development, leadership training, and community engagement opportunities, we foster an environment where you can grow your career alongside diverse colleagues who uphold high ethical standards.
Benefits:
Guardian is dedicated to offering a comprehensive benefits package that includes health care options, life and disability insurance, retirement plans, and generous time-off policies. We prioritize emotional well-being and work-life balance, providing resources to support your mental health and wellness.
Equal Opportunity:
Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.
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