What are the responsibilities and job description for the Clinical Claims Specialist position at J & J Staffing Resources?
We are looking for an experienced RN to join our team at J & J Staffing Resources. In this role, you will review medical claims and identify potential risks for underwriting purposes.
This is a challenging and rewarding opportunity that requires strong analytical and problem-solving skills. You will need to assess claims and medical information to calculate potential risk and identify claimants with catastrophic care needs.
The responsibilities of this role include:
- Reviewing medical records, claims files, and underwriting reports to identify potential risks
- Researching diagnoses, treatment plans, and average costs to inform underwriting decisions
- Communicating with underwriters and Senior Management to advise on potential claims involving significant risk
- Investigating courses of treatment for existing conditions
- Providing written assessments within expected timeframes
The requirements for this role include:
- Registration as a Registered Nurse (RN)
- Three or more years of clinical RN experience, preferably in a hospital setting
- Two or more years of experience in the health insurance industry with in-depth knowledge of the UR and/or case management process
- Strong analytical, organizational, and decision-making skills, as well as business orientation
- Strong computer skills
- Excellent written and verbal communication skills
