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Clinical Consultant, Claims Shared Services
Clinical Consultant, Claims Shared Services-October 2024
Providence
Oct 27, 2024
About Clinical Consultant, Claims Shared Services

  Position Summary

  The Clinical Consultant serves as a clinical resource for the investigation and assessment of medical information regarding disability by providing comprehensive medical reviews and analysis of long-term and or short-term disability claims. The Clinical Consultant identifies restrictions, limitations and duration impacting functional capacity based on medical data, to assist the Case Managers in determining claim liability. The Clinical Consultant collaborates with treating providers to assist individuals to obtain appropriate care and ensure optimal treatment outcomes and acts with urgency and ownership to resolve customer issues and prioritize the customer experience.

  You are:

  A highly motivated and reliable individual who can work with varying levels of supervision- independently or collaboratively. You are detail-oriented and a decisive decision maker who can manage multiple priorities at the same time.

  You have:

  A minimum of 5 years in direct patient care settings

  BSN and CCM preferred

  Excellent verbal and written communication skills and presentation skills

  Ability to exercise independent & sound judgment in decision making

  Strong problem-solving, analytical, clinical, and information research skills

  Excellent time management & organizational skills

  Demonstrated ability to multi-task with the ability to manage continually changing priorities and the ability to prioritize work based on customer service needs and departmental regulations

  The ability to remain flexible due to changing business needs

  Strong knowledge of medical conditions and how they apply to disability products

  Professional oral, written and presentation skills \Strong PC skills, including Microsoft Office applications (MS Word, Excel, PowerPoint)

  Knowledge of disability products, business rules and procedures, preferred

  Experience with DCMS, Claim Facts, and iProcess preferred

  You will:

  Review long-term and or short-term disability claims to assess the impact of claimants’ medical condition on their function as well as the impact of their medical treatment in achieving improved functional outcomes.

  Possess a strong clinical background to understand and apply rationale of how injury or illness may impact the claimant’s function.

  Possess excellent verbal and written communication skills to gather and report information accurately, ask appropriate questions to facilitate partnership with treating providers, claimants, and internal partners to encourage participation of claimant in appropriate treatment goals.

  Conduct analysis of claimant’s current treatment plan and collaborate with health care providers and claimants to promote accountability for the appropriateness and status of treatment plan and length of disability.

  Proactively contact treating providers to discuss treatment plans and clarify treatment and RTW goals. Educate providers and claimants on the positive impact of return to work to ensure improved functional status and medical outcomes.

  Serve as a technical resource on the medical aspect of long-term and or short-term disability claims.

  Identify opportunities to educate claim staff and peers on medical aspect of disability.

  Provide ongoing training and mentoring to claims staff and peers regarding issues impacted by the nature of injury or illness and its impact on function in work or daily activities.

  Work collaboratively with internal vocational rehab specialists in identifying opportunities for return to work.

  Work to proactively identify and resolve customer issues, when possible, to enhance the customer experience.

  Utilize independent vendors to perform independent medical assessments. Specifically define issues to be addressed or clarified by outside physician or provider and oversee quality of review.

  Manage work flow efficiently, organize priorities, provide timely intervention, and implement continuous quality process improvement.

  Reporting Relationships:

  As a Clinical Consultant, you will report to a Clinical Manager, who report to the Head of Disability and Vocational Organization.

  Location:

  Preferred locations include Bethlehem PA; Holmdel, NJ; and Plano, TX. May be open to candidates in other U.S. locations.Travel

  Occasional travel may be required (0-10% of the time).Salary Range

  $56,200.00 - $92,335.00

  The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

  Our Promise

  At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

  Inspire Well-Being

  As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

  Health Care

  Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

  Dental plan

  Vision plan

  Health care accounts – flexible spending, health reimbursement, and health savings accounts

  Critical illness insurance

  Life and Disability Insurance

  Company-paid Life and Disability insurance plus voluntary supplemental coverage

  Accident insurance

  Retirement and Financial

  401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

  Complimentary 1:1 financial guidance with a licensed Fidelity representative

  Time Off and Remote Work

  Flexible work arrangements (part in-person/part remote)

  Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

  Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

  Paid parental leave and paid family and medical leave policies

  Emotional Well-being and Work-Life

  Emotional well-being, mental health, and work/life resources powered by Spring Health

  Wellness programs, including fitness program and equipment reimbursement

  Child, adult, and elder back-up care support through Bright Horizons

  Adoption assistance

  College planning

  Tuition reimbursement

  Student loan assistance

  Commuter benefits in select metropolitan areas

  Justice, Equity, Diversity & Inclusion (J.E.D.I.)

  Employee Resource Groups that advocate for inclusion and diversity

  J.E.D.I. certification and training programs

  Matching gifts/volunteering

  Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

  Equal Employment 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.

  Accommodations

  Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected] .

  Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com .

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