Clinical Claims Care Coordinator I

About illumifin

illumifin is a technology-driven insurance company and third-party administrator focused on creating and delivering innovative insurance policy management software and services. Our solutions integrate insurance expertise, operational excellence, and technological advancements to offer superior value and performance, gearing insurers towards digital transformation. Our core markets include North American life insurance, long-term care, annuities, and health sectors. We prioritize authentic partnerships with clients and have a strong passion for the insurance industry.

Role Overview

The Clinical Claims Care Coordinator plays a critical role in evaluating field assessments completed by assessors. This includes verifying accuracy, thoroughness, and the provision of a clear picture of a policyholder's current functional status for insurance carriers. The role involves clarifying details with field assessors and guiding them on proper completion of interview tools. Additionally, the coordinator develops care plans and certifies chronic illness cases.

Key Responsibilities

• Evaluate onsite assessments for consistency and quality, collaborating closely with field nurses.
• Communicate with field assessors to clarify information, ensuring a comprehensive and high-quality assessment for insurers.
• Compile professional, objective reports summarizing assessment data, following company formatting guidelines.
• Oversee clinical quality reviews of completed assessments.
• Exercise independent judgment aligned with client and company policies and procedures.
• Conduct telephonic and virtual interviews as required.
• Deliver prompt, courteous, and exemplary customer service internally and externally.
• Use strong communication skills, maintain attentiveness, and follow appropriate authority lines, while safeguarding HIPAA compliance and legal confidentiality standards.
• Accurately perform tasks and manage workload prioritization effectively.
• Utilize resources such as equipment and computer systems efficiently.
• Participate in meetings and absorb organizational communications responsibly.
• Adhere to compliance principles as per the Code of Conduct, Employee Handbook, and related policies; actively engage in mandatory Corporate Compliance Program training at least annually.
• Achieve department-defined quality and productivity targets.
• Undertake additional duties when assigned.