Claims Manager - LSW or RN

Job Summary

Evaluating and rendering eligibility decisions on long-term care claims, the full-time Claims Manager - LSW or RN will provide quality customer service while reviewing claims and maintaining documentation in a remote environment.

Key responsibilities

• Review internal databases and policy contracts to evaluate home and facility-based claims
• Communicate with claimants, third parties, and healthcare providers to gather necessary information and verify claims
• Maintain documentation of all claim activities and create plans of care as needed

Required qualifications

• Licensed Social Worker (LSW) or Registered Nurse (RN) credentials
• Experience in evaluating insurance claims or related fields
• Knowledge of healthcare regulations and compliance standards
• Ability to work independently with minimal supervision
• Strong organizational skills and attention to detail