Clinical Claims Care Coordinator I - A

illumifin is an insurance technology company and third-party administrator that designs, develops and delivers tech-enabled insurance policy management software and services that provide unrivaled value for insurers.

We combine insurance insight, operational excellence, and technology innovation to build solutions that deliver high performance and position insurers for the digital world. illumifin is primarily focused on the North American life, long-term care, annuity, and health markets. We believe in true partnerships with our customers and are passionate about insurance.

The Clinical Claims Care Coordinator reviews the assessment that is completed by the field assessor for completeness, accuracy and ensures that the assessment provides the insurance carrier with a clear picture of the policyholder’s current functioning. They also obtain clarifying information from the field assessor and provides guidance to that assessor on the correct completion of the interview tool. A Clinical Claims Care Coordinator will create a plan of care and be required to review and certify for chronic illness.

CLINICAL CLAIMS CARE COORDINATOR RESPONSIBILITIES

• Review onsite assessments for consistency and quality and collaborates with the field nurse.
• Obtain information from the field assessor to clarify information and provide the carrier with a thorough, high quality assessment product.
• Prepare professional, objective report for the insurance customer summarizing information from the assessment using company formats, when appropriate.
• Manages the clinical quality review for the completed assessments.
• Act with independent judgement following client and company policies and procedures.
• Complete telephonic and virtual interviews as need arises.
• Always provides prompt, courteous and excellent customer service to internal and external customers.
• Demonstrate effective communication skills, level of attentiveness and use of appropriate lines of authority. Promptly shares accurate and complete information to others who need it, based on HIPAA and legal documents regarding release.
• Perform work accurately and demonstrate ability to prioritize workload.
• Use supplies and other resources (i.e. equipment, computer systems, tools, energy, etc.) efficiently and effectively.
• Attend or is responsible for information given at meetings and through other organizational channels.
• Uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required.
• Meet established quality and production expectations as established and communicated by the department.
• Other duties as assigned.