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Clinical Claim Management Consultant
Location
United States
Posted
87 days ago
Salary
$69.0K - $113.3K / year
Seniority
Senior
Job Description
Clinical Claim Management Consultant
Guardian Life
• Conduct thorough reviews of clinical claim assessments to ensure accuracy, consistency, and well-supported rationale. • Perform calibration discussions with Seniors and People Leaders. • Deliver clear, concise, constructive, and timely feedback to our clinicians to support continuous improvement. • Identify trends, recurring issues, and potential root causes in clinical review quality. • Collaborate with leadership to develop and implement solutions that address performance gaps and elevate team standards. • Assist people leaders in upskilling the individual/team. • Provide an analysis of team and individual performance highlighting findings and improvement recommendations. • Participate in ad hoc audits, projects, and initiatives as needed. • Provide clinical expertise on complex clinical discussions such as Vendor Referral Discussions. • Flex into clinical review responsibilities during peak periods or staffing needs. • Provides oversight for our Vendor Management Program; invoice management, vendor management, vendor tracking, quality and feedback for our vendors.
Job Requirements
- Registered Nurse (RN) with active license required
- 3+ years clinical claims review experience, prior DI experience or equivalent experience required
- Minimum 1 year experience providing feedback to front line staff and frontline supervisors
- Prior experience with STD, LTD, and/or Appeals a plus
- Prior experience review BH claims
- Prior experience in a quality assurance role a plus
- Prior people manager experience a plus
Benefits
- Health insurance
- Flexible working hours
- Professional development opportunities
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