Clinical Support Specialist

Remote (United States)

Job Details

Employment Type: Full-Time

Compensation: $22.00-$24.00 per hour

About the Role

The Clinical Support Specialist provides administrative and analytical support to a clinical team responsible for reviewing Medicare-related cases. This position helps prepare files for clinical review by organizing medical documentation, reviewing case materials, pricing future care services, and coordinating workflow.

This role requires the ability to learn Medicare Set-Aside processes, manage a high volume of detailed assignments, meet production deadlines, and communicate clearly with clients and internal team members. The position is well suited for someone with strong analytical, organizational, and documentation skills who can work accurately in a remote, task-driven environment.

What You’ll Do

• Conduct preliminary case reviews before files are assigned to Nurse Allocators.
• Review medical records, payment histories, pharmacy records, and related documents to confirm that all materials needed for allocation development have been received.
• Identify missing information or documentation and contact clients to obtain clarification before case completion.
• Extract, organize, and categorize medical records received through client systems.
• Prepare and maintain allocation templates and supporting case documentation.
• Prioritize and coordinate workflow by assigning cases to Nurse Allocators and monitoring task progress.
• Price future care recommendations included in allocations using established pricing resources and systems.
• Assist with the preparation of treating physician statements provided to clients after allocations are completed.
• Support the preparation of allocation reports by reviewing and summarizing medical records, billing records, and medical and pharmacy payment histories.
• Outline an injured individual’s past, current, and anticipated future treatment needs related to the injury.
• Review and extract medical records needed for rated age submissions.
• Prepare documentation requests to obtain information required for rated age submissions.
• Provide additional administrative, analytical, and case support to the Clinical Support Supervisor as needed.

Qualifications

• Previous experience in the medical field is preferred.
• One to three years of experience in the insurance industry is preferred.
• Five or more years of Medicare Secondary Payer clinical experience is preferred.
• Professional certification such as MSCC, CMSP, CLCP, or CNLCP is preferred.
• Proficiency with Microsoft Office, including Word and Excel for document preparation and data management.
• Ability to manage multiple assignments in a high-volume environment while maintaining accuracy and attention to detail.
• Strong written and verbal communication skills with the ability to present information clearly.
• Ability to meet established deadlines in a fast-paced, production-driven environment.
• Strong interpersonal, organizational, and time-management skills.
• Ability to work independently in a remote setting and collaborate effectively with a team.
• Strong analytical skills and the ability to review detailed medical, billing, pharmacy, and case documentation.
• Consistent attention to detail and a commitment to high-quality work.
• Ability to learn and understand Medicare Set-Aside processes.

Benefits

• 100% employer-paid medical insurance for employees.
• Dental and vision coverage.
• 401(k) retirement plan with employer matching contributions.
• Employer-paid life insurance.
• Optional short-term disability coverage.
• Optional accident insurance and additional voluntary benefits.
• Paid time off.
• Paid holidays.
• Supportive and team-oriented work environment.