Claims Clinical Specialist - Medical Review Team

At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are.

Further, we are the spouses, children, siblings, friends, and neighbors of those that need care and we bring those experiences with us to work in serving our millions of policyholders each day.

We apply that same compassion and empathy as we work with each other and our local communities, Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed.

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We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.

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Make it human. We care about the people that make up our customers, colleagues, and communities.

Make it about others. We do what’s best for our customers and collaborate to drive progress.

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POSITION TITLE

Claims Clinical Specialist Medical Review Team

POSITION LOCATION

This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid 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

As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders now and in the future.

The Claims Clinical Specialist role is an excellent opportunity for a Registered Nurse seeking a career change. Bring your nursing knowledge and experience, and Genworth will provide the training necessary to succeed as a Medical Review Nurse.

You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing assessments, and monitoring low-risk claimants.

This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.

What you will be doing

You will be responsible for communicating with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy.

You will be responsible for obtaining information about the medical status and care needs of the insured to best understand the disease progression, ADL / IADL loss, and cognitive status.

You will be responsible for making decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification.

You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.

You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.

You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL / IADL loss and potential for recovery.

You will identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results.

What you bring

Active Registered Nurse (RN) licensure

At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical / cognitive function, as well as their prognosis and rehabilitative potential.

Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational / Physical Therapist records and understand disease progression and recovery expectations.

Extraordinary internal and external customer service skills including patience, tactfulness, ability to remain calm and composed under pressure, effective listening skills, and professionalism.

Able to manage and prioritize a work queue and multiple job responsibilities.

You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business.

Ability to understand and Interpret Insurance Contracts and Long-Term Care Benefits.

Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.).

Nice to Have

Bachelor’s Degree in Nursing, similar sciences, or higher postgraduate education

At least 2 years of medical experience with older adults and their families (hospital, nursing home, or community placements).

Experience in a Long -Term Care and / or Hospice setting

Strong knowledge of senior / geriatric / home health care, continuum of care, long-term care insurance and / or the Medicare program.

Geriatric medical knowledge.

Employee Benefits & Well-Being

Genworth employees make a difference in people’s lives every day. We’re committed to making a difference in our employees’ lives.

Competitive Compensation & Total Rewards Incentives

Comprehensive Healthcare Coverage

Multiple 401(k) Savings Plan Options

Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)

Generous Paid Time Off Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave

Disability, Life, and Long Term Care Insurance

Tuition Reimbursement, Student Loan Repayment and Training & Certification Support

Wellness support including gym membership reimbursement and Employee Assistance Program resources (work / life support, financial & legal management)

Caregiver and Mental Health Support Services

ADDITIONAL

The base salary pay range for this role starts at a minimum rate of $ 65,600 up to the maximum of $121,300. In addition to your base salary, you will also be eligible to participate in an incentive plan.

The incentive plan is based on performance and the target earning opportunity is 7% of your base compensation. The final determination on base pay for this position will be based on multiple factors at the time of this job posting including but not limited to geographic location, experience, and qualifications to ensure pay equity within the organization.