LTC Claims Pending Specialist - Remote USA.

About the role

Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy.

Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine the eligibility of long-term care claims including reimbursement of eligible expenses.

Conduct interviews to gather pertinent claim information from the insured or their representative.

Answer incoming calls from the field and insureds or their representatives to explain claims status, hypothetical claim situations, and contract provisions.

Communicate effectively verbally and in writing with Insureds and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources, which involves negotiation and conflict resolution.

Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.

May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements.

Work cohesively with team members to meet the goals of the team and division.

Qualifications

• Registered Nurse or Social Work license preferred
• Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable
• A bachelor's degree or equivalent combination of education and work experience will be considered
• Experience with insurance claims is desirable
• Strong written and verbal communication skills required
• Strong technology skills required
• Ability to analyze medical records and draw out necessary information for claims processing
• Demonstrates initiative and strong support of team goals and results
• High degree of analytical skills, personal organization, and time management
• Strong client focus and customer service skills
• Ability to manage ambiguity and maintain a positive outlook in the face of change
• Ability to identify process improvement opportunities

Skills

• Problem Management (NM) - Intermediate
• Prioritization (NM) - Intermediate
• Empathetic Communication (NM) - Intermediate
• Insurance Acumen (NM) - Beginner
• Customer Centricity (NM) - Intermediate
• Learning Agility (NM) - Intermediate
• Analytical Thinking (NM) - Intermediate
• Insurance Contract Management (NM) - Beginner
• Adaptive Communication (NM) - Intermediate
• Information Gathering (NM) - Beginner
• Decision Making (NM) - Intermediate
• Attention to Detail (NM) - Intermediate
• Change Adaptability (NM) - Intermediate
• Claims Acumen (NM) - Intermediate
• Data Application (NM) - Beginner

Benefits

• Flexible work schedules
• Concierge service
• Comprehensive benefits
• Employee resource groups

Pay

Pay Range - Start: $60,880.00

Pay Range - End $91,320.00

Geographic Specific Pay Structure: $66,960.00 USD - $100,440.00 USD (Structure 110)

$70,000.00 USD - $105,000.00 USD (Structure 115)

Please note that final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process.

Schedule

The hours of operation for this role will be 8:30 AM to 5:00 PM CST. You must be able to work these core hours.