Exl Service

  • Lead Disability Claims Nurse (RN)

    Job Location US-FL-Tampa
    ID
    2018-4968
    Group
    Global Client Services
    Type
    Regular Full-Time
  • Overview

    As a Lead Disability Claims Nurse, you will perform the medical retrieval, summarization and low complexity nurse review and lead the claims associates. You will need the knowledge and skills to conduct thorough investigations of disability claims. This is a fast-paced job where attention to detail counts. The Lead Disability Claims Nurse will be a leader which will have direct impact on claimant health, well-being and sense of security. This person must have the ability to make effective decision and communicate decisions within tight time frames, while integrating knowledge of medical conditions, customer contracts, and corporate compliance are critical for success.

    Responsibilities

    Job Responsibilities:

    Leadership/Coaching: Provides overall guidance to teams on a day-to-day basis. Coach teams to be able to identify inquiries and take appropriate actions.

    Career Development/Performance & Dialogue: Set goals and standards of performance for claims associate which are linked to business goals.

    Issue Resolution: Investigates and resolves issues as required – whether customer issues or team issues.

    As a Lead Disability Claims Nurse, You Are Responsible for:

    • Preparation of claims for medical retrieval, summarizations, vendor rehabilitation (return to work) which include short-term, long-term and rehabilitation disability and supervision of claims professional. The success of this work will be through capturing medical information, applying appropriate contractual provisions (scope of work), following legal guidelines, and support the team as a subject matter expert.
    • Having direct communication with claimants, employers, and various medical professionals to gather information regarding the claim for, short-term, long-term and rehabilitation disability benefits.
    • Support and promote all integration initiatives.
    • Handle potentially high levels of inbound correspondence from claimants and medical professionals. There correspondences maybe via written, faxed and/or emails response of the request for medical records. Also guide the disability claims associate as they perform task.
    • Work directly with clients to facilitate return to work assessments.
    • Network with both claimant and physicians to gather medical records, labs, diagnostic test and any other pertinent medical requests for review and ongoing evaluation of medical information. Also guide the disability claims associates performing task.
    • Delivery of clients expectations outlined in the scope of work (SOW).
    • Adherence to standard timeframes for processing mail, tasks and outliers as outlined in the scope of work. Also guide the disability claims associate performing task.
    • Understand Operations and Corporate Compliance, Policies and Procedures and Best Practices.
    • Stay abreast of ongoing trainings associated with role and business unit objectives.
    • Respond to all telephonic and email inquiries within client service protocols (SOW) in a clear, concise and timely manner. Also guide the disability claims associates performing task.

    Other duties as outlined by leadership.

    Qualifications

    Qualifications:

     

    Long Term Disability, Short Term Disability, Low Complexity Nurse Review and Vocational Rehabilitation Service. 

    Leadership skills. 

    Strong interpersonal and demonstrated team-building and coaching skills, proven teamwork and collaboration. 

    Demonstrated analytical and clinical critical thinking skills.

    In-depth knowledge and understanding of the Independent Medical Examination process.

    In-depth knowledge and understanding of the High Level Review process. 

    Proven ability to organize and prioritize; demonstrated success in multitasking and managing multiple, competing priorities.

    Strong ability to communicate at all levels with clarity and precision, both written and verbal.

    Ability to adapt in a changing work environment.

    Advanced technical/computer skills, including MS Word, Excel, PowerPoint, Share Point, etc.

     

     

    Education:

     

    Associate Degree in Nursing   

    Registered Nurse with current, valid unrestricted licensure in the state of Florida.

    Degree from an institution that is fully accredited by a nationally recognized educational accreditation organization.

    Work Experience Requirements:

     

    Work experience in Long Term Disability, Short Term Disability, and Vocational Rehabilitation Service. 

     

     

     

    EEO Statement

    EEO/Minorities/Females/Vets/Disabilities

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