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Role Description

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 spends 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. 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. As our client list and capabilities grow, our opportunities also grow.

This position uses your eldercare expertise and excellent communication skills to assure that the company serves our clients with the highest degree of quality, respect, and customer service. The successful candidate must be caring and empathetic with claimants, members, and their families.

• Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
• 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.
• Work with new clients to develop processes that meet their insureds’ needs.

Qualifications

• RN with a current license in Massachusetts, New York, Illinois, Minnesota, Michigan, Pennsylvania, Washington or residing in a Nursing License Compact state with compact licensure.
• 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. Proficient with workflow management tools and a CRM.
• Ability to data input into a CRM while discussing care needs as with a claimant or member.
• Excellent communication skills, both oral and written, with a customer service focused attitude to build rapport and relationships.
• Ability to meet daily tracked standards in both production and quality.
• Demonstrate technical and professional expertise through problem resolution, while maintaining composure. Ability to effectively communicate with both internal and external customers at all levels.
• Strong multi-tasking, time management and follow-up skills to complete tasks in time sensitive manner.
• Ability to independently resolve service issues and follow escalation protocol on issues.
• Ability to make positive impressions over the phone and build rapport with clients, despite conversations that can be difficult or emotion filled.
• Ability to work remotely in a quiet environment with strong, reliable internet while maintaining production levels.

Requirements

• BSN or equivalent.
• Knowledge of Long Term Care settings and residents.
• Previous experience with Long Term Care, Medicare, or Medicaid Assessments.
• Uniform Assessment System certification.
• Telephonic case management experience.

Benefits

• Competitive Compensation & Total Rewards Incentives.
• Comprehensive Healthcare Coverage.
• Multiple 401(k) Savings Plan Options.
• 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.