Claims Clinical Specialist - Medical Review Team

Genworth Financial, Inc.

Job Overview

Location

Remote (US)

Job Type

Full-time

Full Job Description

📋 Description

• As a Claims Clinical Specialist on the Medical Review Team, you will play a crucial role in delivering world-class customer service and capabilities to Genworth’s long-term care insurance policyholders by applying your clinical expertise to assess care needs, determine benefit eligibility, and support evidence-based case management.
• Day to day, you will conduct telephonic assessments with medical personnel at long-term care facilities, obtain and analyze medical records (including MDS, physician, and therapy notes), develop plans of care, and make decisions about benefit eligibility aligned with policy requirements and HIPAA regulations for tax qualification certification.
• You will join Genworth’s Operations team, a mission-driven organization committed to empowering families through compassionate, inclusive, and values-based care—guided by the principles of making it human, about others, happen, and better.
• In this role, you will deepen your clinical and insurance expertise, contribute to process improvements, collaborate across teams, and grow professionally through training, certification support, and tuition reimbursement while making a tangible impact on policyholders’ lives.

🎯 Requirements

• Active Licensed Social Worker or Registered Nurse credential
• Minimum two years of experience working with single and cumulative medical conditions common in aging, including understanding their impact on physical/cognitive function, prognosis, and rehabilitative potential
• Ability to interpret MDS, Plan of Care, physician, and occupational/physical therapist records to assess disease progression, ADL/IADL loss, and cognitive status
• Demonstrated experience in making sound business decisions using risk management and quality protocols
• Ability to manage and prioritize work queues and multiple responsibilities with consistent, reliable attendance
• Good working knowledge of Microsoft Office applications (WORD, EXCEL, PowerPoint, etc.)

🏖️ Benefits

• Competitive compensation with base salary range of $67,000 to $124,600 and eligibility for an incentive plan targeting 7% of base pay based on performance
• Comprehensive healthcare coverage, multiple 401(k) savings plan options, and auto-enrollment in a 100% employer-funded retirement account
• Generous paid time off including 12 paid holidays, volunteer time off, and paid family leave, plus disability, life, and long-term care insurance
• Tuition reimbursement, student loan repayment assistance, and support for training and certification
• Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life, financial, legal)
• Caregiver and mental health support services to promote employee well-being

Skills & Technologies

Remote

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Genworth Financial, Inc.

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About Genworth Financial, Inc.

Genworth Financial, Inc. empowers families to confidently navigate the complexities of aging by providing a comprehensive suite of financial solutions, primarily focused on long-term care insurance, life insurance, and annuities. Through products like CareScout, they offer valuable tools for researching care costs, estimating coverage needs, and connecting policyholders with high-quality home care agencies. With a legacy of surveying long-term care providers across the country since 2004, Genworth demonstrates deep expertise and commitment to supporting individuals and financial professionals in planning for the future. The company is dedicated to fostering an inclusive work environment that prioritizes employee well-being and community involvement.

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