Clinical Specialist LPN/RN, Disability Claims

Guardian makes a difference in the lives of people when they need us most. With over 160 years of stability and fiscal integrity, we are a trusted resource to generations of families and business owners, inspiring well-being and helping build financial confidence. Today, we stand behind 29 million consumers, helping them prepare and plan for a bright future for themselves and their families. We help business owners care for their employees. And we help people recover and thrive in times of unexpected loss. As a modern mutual insurance company, we believe in driving value beyond dividends. We invest in our colleagues, are building an inclusive and innovative culture, and are helping to uplift communities through thoughtful corporate impact programs.

As the Clinical Specialist LPN/RN, Disability Claims you will perform necessary outreaches to claimants or treating providers to obtain certification dates, treatment plans and any other pertinent medical information necessary to facilitate and assist claims managers in adjudicating disability claims decision. They will leverage their medical knowledge to determine what medical information is needed and perform the necessary steps needed to obtain this information. This individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to facilitate timely claim decisions. You are: Knowledgeable in a variety of medical and behavioral health conditions Vendor management: Works collaboratively with vendors to schedule and follow up for vendor reports Excellent written and verbal communication skills Ability to exercise independent & sound judgment in decision making Excellent time management & organizational skills Multitasking with the ability to manage continually changing priorities and ability to prioritize work based on customer service needs and departmental regulations. Self-motivated & able to work independently. Ability to work collaboratively with multiple professional disciplines and with diverse populations. Current medical knowledge of medical conditions and treatment is maintained via continuing education

Review information in file, obtain medical information needed and/or acquire certification of disability and limitations from treating physicians Assist with Vendor Management Document clear and concise details regarding certification dates, treatment plans as well as other pertinent claim information identified. Collaborate with the Claims Case Manager and the Claimant to facilitate timely physician outreaches and collection of medical information Remain flexible to changing business needs and assist the team where needed in order to meet the needs of our customers