Long Term Care Claims Specialist

Job Summary

Responsible for the accurate evaluation and management of Long Term Care claims, the full-time Long Term Care Claims Specialist will work remotely to analyze medical and contractual information, determine eligibility for benefits, and ensure compliance while maintaining effective communication with claimants and stakeholders.

Key responsibilities

• Evaluate and manage Long Term Care claims throughout the claim lifecycle, making informed decisions based on policy provisions and supporting documentation
• Gather and analyze claim information to determine eligibility and benefit payments, ensuring compliance with contract terms
• Maintain strong relationships and communication with claimants, employers, and medical professionals to support effective claim resolution

Required qualifications

• Ability to analyze and interpret insurance policies and regulations for accurate claim decisions
• Experience in delivering strong customer service through clear verbal and written communication
• Demonstrated analytical thinking and decision-making skills in claims management
• Proficiency in Microsoft Office and basic medical terminology
• Access to a high-speed internet connection and located in the United States or Puerto Rico