Note: The job is a remote job and is open to candidates in USA. Guardian Life is an insurance company looking for a Senior Clinical Consultant to collaborate with Clinical and Vocational Leaders. This role involves providing coaching and oversight to Clinical Consultants, ensuring accurate assessments, and promoting organizational excellence through leadership and problem-solving.
Responsibilities
- Train and mentor all new Clinical Consultants
- Provide ongoing training, coaching and development to all Clinical Consultant members
- Organize and present at least one Clinical Training session for the Claims teams over the course of a year
- Work with Team Manager to delegate, distribute, and monitor workloads within the department to meet departmental regulations, improve efficiency and reduce or eliminate backlogs
- Assist Team Manager when needed to monitor caseloads, productivity, and participate in calibration sessions with our Clinical CMA and provide feedback to leadership and team members
- Oversee external vendor utilization within team
- Leverage knowledge and skills to flex and assist the overall team meet its goals, (i.e., assist with STD/LTD/ Appeals, flex and assist if needed)
- Collaborate with claims partners to resolve conflicts and establish procedures that promote clinical claim management accuracy and improved customer service
- Address escalated customer inquiries and formal complaints. Senior BHCM will also be first point of contact for SI or mental health crisis calls
- Support training initiatives by identifying knowledge gaps and providing ideas for improvement
- Support Clinicians in developing efficient desk & time management skills
- Collaborate with peers and leadership to ensure consistency with mentoring and coaching
- Co-facilitate team meetings to share best practices, workflow changes, trends, and insights in alignment with Group benefits strategies
- Provide desk coverage for leadership as needed
- When not engaged in the above activities are expected to meet the same metrics and performance objectives as a Clinical Consultant
Skills
- A minimum of 5 years of (STD, LTD, Appeals) claim experience, minimum of 2 years disability experience
- A minimum of 5 years in direct patient care settings
- 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
- Proven ability to mentor and coach
- Proficiency in MS Word, Excel, PowerPoint, DCMS, Claim Facts, and iProcess
- BSN and CCM preferred
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