LTC Claims Pending Specialist - Remote USA.
$60,880–$60,880 year
RemoteUnited States
Job Summary
Determine the applicability of benefits by interpreting contract provisions and state regulations to reach claim decisions on new and continuing claims. Order and review medical, investigative, and service provider information to verify eligibility and reimbursement. Conduct interviews to gather pertinent claim information from insureds or their representatives. Answer incoming calls to explain claims status, hypothetical situations, and contract provisions. Communicate effectively with insureds, field force, medical practitioners, attorneys, and other service providers, including negotiation and conflict resolution. Preserve the company's reputation during approval or denial of benefits despite difficult circumstances. May serve as a Subject Matter Expert for project and committee work involving process improvements. Work core hours from 8:30 AM to 5:00 PM CST.
Required Qualifications
- Strong written and verbal communication skills
- Strong technology skills
- Ability to analyze medical records and draw out necessary information for claims processing
- Ability to manage ambiguity and maintain a positive outlook in the face of change
- Ability to identify process improvement opportunities
- High degree of analytical skills, personal organization, and time management
- Strong client focus and customer service skills
- 8:30 AM to 5:00 PM CST core hours
Desired Qualifications
- Registered Nurse or Social Work license
- Healthcare background
- Minimum 3+ years of long-term care insurance experience
- Experience with insurance claims
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