Job Description

Position Title
Associate Claims Clinical Specialist

Location

This position is available to Massachusetts residents as Waltham, Massachusetts in-office applicants, or remote applicants residing in states/locations under Eastern or Central Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin.

Your Role
The position of Associate Claims Clinical Specialist plays a leading role in the insured or member\xe2\x80\x99s assessment process. We provide services to a variety of clients, all that require your deep knowledge of long-term care needs of an aging or chronically ill population. You will be part of a remote team of clinicians that spends their days reviewing clinical assessments completed by field assessors and writing Plans of Care for Long Term Care Insurance and other government sponsored insurance plans. Some days will be spent reaching out to claimants or members, their families, or facilities to discuss updates to their health and develop a plan of care. As our client list and capabilities grow, our opportunities also grow.
This position uses your eldercare expertise and excellent communication skills to assure that the company serves our clients with the highest degree of quality, respect, and customer service. The successful candidate must be caring and empathetic with claimants, members, and their families.

What You Will Be Doing

• Reviewing clinical assessments completed by field assessors to determine chronic illness status and develop a plan of care with supporting written documentation.
• Collaborate with field assessors and facility staff via phone to determine if further information is needed on a claimant or member\xe2\x80\x99s health status
• Call claimants, family members or facility staff to update records on their present health status and provide a new plan of care.
• Work with new clients to develop processes that meet their insureds\xe2\x80\x99 needs.

Must Have/What You Bring

• RN with a current license in Massachusetts, New York, Illinois, Minnesota, Michigan, Pennsylvania, Washington or residing in a Nursing License Compact state with compact licensure.
• A minimum of 3 years of professional clinical experience in case management, home care, or a rehabilitation setting, preferably with a geriatric population.
• Strong knowledge of Microsoft applications to include: Outlook and Word. Proficient with workflow management tools and a CRM
• Ability to data input into a CRM while discussing care needs as with a claimant or member.
• Excellent communication skills, both oral and written, with a customer service focused attitude to build rapport and relationships.
• Ability to meet daily tracked standards in both production and quality.
• Demonstrate technical and professional expertise through problem resolution, while maintaining composure. Ability to effectively communicate with both internal and external customers at all levels
• Strong multi-tasking, time management and follow-up skills to complete tasks in time sensitive manner.
• Ability to independently resolve service issues and follow escalation protocol on issues
• Ability to make positive impressions over the phone and build rapport with clients, despite conversations that can be difficult or emotion filled.
• Ability to work remotely in a quiet environment with strong, reliable internet while maintaining production levels.

Nice to Have

• BSN or equivalent
• Knowledge of Long Term Care settings and residents
• Previous experience with Long Term Care, Medicare, or Medicaid Assessments
• Uniform Assessment System certification
• Telephonic case management experience

What We Offer

• We have a real impact on the lives of the people we serve
• We work on challenging and rewarding projects
• We give back to the communities where we live
• We offer competitive benefits including:

• Medical, Dental, Vision, Flexible Spending Account options beginning your first day
• Generous Choice Time Off your first full year
• 12 Paid Holidays
• 40 hours of volunteer time off
• 401K Account with matching contributions
• Tuition Reimbursement and Student Loan Repayment
• Paid Family Leave
• Child Care Subsidy Program

About Us

CareScout is a growing company with an entrepreneurial culture providing customized care plans and elder care referral services improving the quality of life for families and their aging loved ones. At CareScout, our promise to our employees is to provide the opportunity to make a meaningful difference in the lives of our customers, communities, and one another, each and every day. CareScout is a wholly owned subsidiary of Genworth which means our employees get the best of both worlds; the ability to have a real impact on an independently operated business as well as the benefits offered by the backing of a Fortune 500 company.

We know we can\xe2\x80\x99t deliver on our mission unless we deliver for our employees. That\xe2\x80\x99s why we\xe2\x80\x99re committed to creating a work environment that fosters diversity, inclusion, camaraderie, rewarding work, community involvement, and a focus on our employees\xe2\x80\x99 well-being. We know each employee contributes in their own unique way and we\xe2\x80\x99re dedicated to supporting every one of them to help them reach their full potential.

Genworth