Claims Clinical 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 values 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 POSITION LOCATION This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in‑office applicants or 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 telephonic assessments, and monitoring claimants with multiple health conditions. 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 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. Obtaining information about the medical status and care needs of the insured to best understand disease progression, ADL/IADL loss, and cognitive status. Making decisions about care‑need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and HIPAA regulations related to tax qualification certification. Identifying, requesting, and analyzing pertinent medical records required to best understand disease progression, ADL/IADL loss, and potential for recovery. Working within a structured environment with established SOPs to ensure consistency of claims practices. Identifying process‑improvement opportunities, providing feedback on processes and the case‑management model, and being a critical team member in enhancing the team's performance and results. Communicating, teamwork, 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 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, prognosis, and rehabilitative potential. Ability 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. Ability to manage and prioritize work queues and multiple job responsibilities. 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 applications (e.g., Word, Excel, PowerPoint). Employee Benefits & Well‑Being Competitive compensation and total rewards incentives. Comprehensive health‑care 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. Caregiver and mental‑health support services. ADDITIONAL The base salary range for this role starts at a minimum rate of $65,500 up to the maximum of $126,300. In addition to the base salary, you will also be eligible to participate in an incentive plan. The incentive plan is based on performance and the target earning opportunity is 7 % of your base compensation. The final determination on base pay for this position will be based on multiple factors at the time of this job posting, including but not limited to geographic location, experience, and qualifications to ensure pay equity within the organization. #J-18808-Ljbffr