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1 Clinical Nurse Specialist Job in Maine, NY

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Reliance Standard Life Insurance Company
Maine, NY | Full Time
9 Months Ago
Clinical Nurse Specialist
Full Time | Insurance 9 Months Ago
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Reliance Standard Life Insurance Company is Hiring a Clinical Nurse Specialist Near Maine, NY

Job Information Job Summary: Reviews all medical (and other) documentation in claim files to answer the specific questions posed by claims examiners and managers. Coordinates and monitors independent medical examinations, peer reviews and functional capacity evaluations. Duties and Responsibilities: Determines whether questions posed by claims examiners and/or management can be appropriately addressed by the Clinical Nurse Specialist. If not, refer the file to the appropriate member of the Technical Support team or return the file with a complete explanation. Ensures that appropriate files are presented to physicians and/or specialists for review. Reviews and evaluates the medical (and other) records contained within the claim file and responds to the specific question(s) posed by the claims examiner or manager. Performs case management responsibilities as required. Serves as a resource for examiners and consults with them about medical issues as necessary and provides reference information on the disease/ medical conditions where appropriate. Assists with training of Claims Department personnel as requested by management, and provides feedback regarding training opportunities (Huddles, Lunch & Learns, team meetings, etc.). Participates in sales presentations as requested. Schedules and monitors independent medical examinations, peer reviews and functional capacity evaluations. May work with affiliated companies to achieve corporate results. Suggests improvements to processes, procedures and products as appropriate. May testify as necessary in legal proceedings. Participates in Claims Discussion Meetings (CDM’s) with claims examiners and supervisors to review and discuss complex claims. Maintains monthly metrics tracking of designated activities. All other duties as assigned. Education, Qualifications and Experience: BSN degree preferred. Minimum of three (3) years of related experience. Registered Nurse with current state licensure. Strong clinical, case management and behavioral health experience preferred. Experience with the processing of insurance claims required. Experience with the handling of long-term disability claims or integrated disability claims preferred. Proven ability to work well in a high visibility, public oriented environment, with excellent written and verbal communication skills. Proven ability to work with the following equipment: P.C. Microsoft Office, (including Word and Excel), telephone, fax machine, calculator. Prior experience using an automated claim system desirable. Some travel may be required. Work location may be flexible if approved by the Company except that position may not be performed remotely from Colorado. EEO Statement Reliance Standard Life Insurance is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, national origin, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment with Reliance depends solely on your qualifications.

Job Summary

JOB TYPE

Full Time

INDUSTRY

Insurance

POST DATE

06/16/2022

EXPIRATION DATE

10/28/2022

WEBSITE

ceorsli.com

HEADQUARTERS

Seattle, WA

SIZE

<25

INDUSTRY

Insurance

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The job skills required for Clinical Nurse Specialist include Verbal Communication, etc. Having related job skills and expertise will give you an advantage when applying to be a Clinical Nurse Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Clinical Nurse Specialist. Select any job title you are interested in and start to search job requirements.

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