Long Term Care Claims Specialist

Job Summary

Evaluating and managing Long Term Care claims throughout the claim lifecycle, the full-time Remote Long Term Care Claims Specialist will analyze medical and contractual information to determine eligibility for benefits and ensure compliance with regulations while delivering high-quality customer service.

Key responsibilities

• Evaluate, adjudicate, and manage Long Term Care claims from initial notification through resolution
• Gather and analyze claim information to determine eligibility and ensure accurate financial calculations
• Maintain effective communication with claimants, employers, and medical professionals to support claim resolution

Required qualifications

• Current working experience with Long Term Care claims adjudication
• Proven ability to analyze and interpret insurance policies and regulations
• Strong customer service and communication skills, both verbal and written
• Analytical thinking and decision-making skills for effective claims management
• Technical proficiency in Microsoft Office and basic medical terminology