Licensed Clinical Claims Specialist

Job Summary

A company is looking for a Claims Clinical Specialist.

Key Responsibilities

• Conduct telephonic assessments and communicate with medical personnel to develop care plans and provide necessary certifications
• Obtain and analyze medical information to understand disease progression and care needs of insured individuals
• Identify process improvement opportunities and collaborate with teams to enhance performance and support continuous improvement initiatives

Required Qualifications, Training, and Education

• Active Licensed Social Worker or Registered Nurse
• At least two years of experience in understanding medical conditions related to aging
• Ability to interpret medical records and understand disease progression
• Experience in making sound business decisions using risk management protocols
• Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint)