LPN Clinical Claims Consultant

Job Summary

A company is looking for a Clinical Claims Consultant to support their claims team.

Key Responsibilities

• Review complex claims and make informed decisions regarding various types of claims
• Provide training and mentoring to less experienced claims staff, including feedback and coaching
• Manage appeal reviews and responses, focusing on risk mitigation and customer experience improvement

Required Qualifications

• Must hold a state-issued LPN license
• Knowledge of contract terminology is highly desired
• Experience with industry claims systems such as Fineos and appeal practices
• Demonstrated leadership skills
• Medical or health claims experience, particularly with cancer claims, is preferred