Genworth · 1 month ago
Claims Clinical Specialist
United States
Full-time
Remote
Entry, Mid Level
$66K/yr - $126K/yr
2+ years expGenworth is a company that empowers families to navigate the aging journey with confidence. The Claims Clinical Specialist role involves delivering world-class customer service by conducting telephonic assessments, managing claims, and providing evidence-based case management services for long-term care insurance policyholders.
FinanceFinTechProperty & Casualty InsuranceFinancial ServicesInsurance
Responsibilities
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 identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery
You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices
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
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
Qualification
Required
Active Licensed Social Worker or Registered Nurse
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
Demonstrated experience in making sound business decisions using risk management and quality protocols
Able to manage and prioritize work queues 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.)
Benefits
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
Company
Genworth
Genworth is an insurance company that is dedicated to help people secure their financial lives, families, and futures.
1001-5000 employees
Funding
Current Stage
Public CompanyTotal Funding
$450.1M2018-03-07Post Ipo Debt· $450M
2016-10-23Acquired
2016-10-09Post Ipo Equity· $0.1M
Leadership Team
Thomas J. McInerney
Chief Executive Officer
Michael S. Laming
SVP Human Resources
Recent News
2026-05-21
legacy.thefly.com
2026-05-06
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