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Clinical Consultant, Claims Shared Services - Bethlehem

Guardian Life

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 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 applicant_accommodationglic.com. Apply Now
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