Care Scout
Associate Claims Clinical Specialist
Remote (Virginia)
Sponsorship not specified$56k-$81kDetected 26 days ago
CRMOutbound SalesCustomer SupportCommunicationCritical ThinkingTime ManagementMicrosoft Office
About the role
- The position of Associate Claims Clinical Specialist plays a leading role in the insured or member's assessment process.
- We provide services to a variety of clients, all that require your deep knowledge of long-term care needs of an aging or chronically ill population.
- You will be part of a remote team of clinicians that spend their days reviewing clinical assessments completed by field assessors and writing Plans of Care for Long Term Care Insurance and other government sponsored insurance plans.
Responsibilities
- Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
- Work with new clients to develop processes that meet their insureds' needs.
Requirements
- 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.
- Ability to data input into a digital platform while discussing care needs with a claimant or member
- Ability to handle inbound and outbound calls with claimants, family members, facilities and agencies
- Ability to meet daily tracked standards in both production and quality.
- Demonstrate technical and professional expertise through problem resolution, while maintaining composure.
- Ability to independently resolve service issues and follow escalation protocol on issues
- RN with a current license residing in a Nursing License Compact state with licensure in their residential state and a Nursing Compact License
- Strong knowledge of Microsoft applications to include Outlook and Word. Proficient with workflow management tools and CRM
- Excellent communication skills, both oral and written, with a customer service focused attitude to build rapport and relationships
- Demonstrate technical and professional expertise through problem resolution, while maintaining composure. Ability to effectively communicate with both internal and external customers at all levels
- Robust critical thinking capabilities, coupled with the ability for independent decision making
- Ability to make positive impressions over the phone and build rapport with clients, despite conversations that can be difficult or emotion filled
Nice to have
- BSN or equivalent
- Knowledge of Long-Term Care settings and residents
- Previous experience with Long Term Care, Medicare, or Medicaid Assessments
- Telephonic case management experience
Skills
- Excellent computer, data input and technical skills including working with multiple screens.
- Strong multi-tasking, time management and follow-up skills to complete tasks in time sensitive manner
- Actual compensation will vary based on geographic location, experience, skills, and other job-related factors.
Compensation
- Disclaimer: This role is aligned to a national market-based pay range.
Benefits
- Competitive Compensation & Total Rewards Incentives
- Comprehensive Healthcare Coverage
- Auto 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
- Some days will be spent reaching out to claimants or members, their families, or facilities to discuss updates to their health and develop a plan of care.
- 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
- In addition to base salary, this role is eligible to participate in a bonus incentive plan.
Company info
- Incentive compensation is based on individual and company performance and is not guaranteed.
- We are the children, siblings, neighbors, and friends of those navigating the fragmented and confusing system of long-term care.
- Our team is ferociously curious and relentless in our pursuit of a better system - and we are deeply committed to a sense of belonging for all, in all phases of life.
- We work hard, we have fun, we care about each other, and we share the mission.
Apply directly at Care Scout →Create a free account for alerts like thisView Care Scout immigration profile
This listing is sourced directly from Care Scout's careers page and normalized into a canonical job model.