Care Coordinator- LTC Claims

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative.
• In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
• Determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
• Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences, internally and with the client, to present claims recommendations.
• Meet quality and production metrics as established and communicated by the department.

Requirements

Commensurate with experience.

Qualifications

• Bachelor’s degree in healthcare, social work, psychology, or related field.
• At least 2 years of experience in long-term care insurance administration or a related field.
• Strong analytical skills and attention to detail.
• Excellent communication skills, both verbal and written.
• Proficiency in Microsoft Office Suite.

Skills

• Knowledge of long-term care insurance policies and regulations.
• Ability to manage multiple tasks and meet deadlines.
• Experience with data analysis and interpretation.
• Strong problem-solving and decision-making abilities.

Benefits

Commensurate with experience.

Pay

Commensurate with experience.

Schedule

Commensurate with experience.