Licensed LTC Claims Specialist

Job Summary

Determining eligibility for long-term care claims, the full-time Licensed LTC Claims Specialist will interpret contract provisions, conduct interviews, and communicate effectively with insureds and service providers while working remotely.

Key responsibilities

• Interpret contracts and state regulations to assess claims eligibility and make decisions on new and continuing claims
• Order and review necessary medical and investigative information to support claims processing
• Conduct interviews and answer calls to gather claim information and explain claims status to insureds and their representatives

Required qualifications

• Registered Nurse or Social Work license preferred
• Healthcare background or a minimum of 3+ years of long-term care insurance experience highly desirable
• Bachelor's degree or equivalent combination of education and work experience
• Experience with insurance claims is desirable
• Strong technology skills and ability to analyze medical records for claims processing