Claims Clinical Specialist - In-House Certification Specialist

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. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.

Our four values guide our strategy, our decisions, and our interactions:

• 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.

• Make it happen. We work with intention toward a common purpose and forge ways forward together.

• Make it better. We create fulfilling purpose-driven careers by learning from the world and each other

POSITION TITLE
Claims Clinical Specialist - In-House Certification Specialist

POSITION LOCATION
This position is available to 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 In-House Certification Specialist is an excellent opportunity for a Registered Nurse or Licensed Social Worker. 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 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 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.

What You Bring

• 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 th