LTC Claims Appeals Specialist

Job Summary

A company is looking for an LTC Claims Appeals Specialist.

Key Responsibilities:

• Handle complex adjudication and correspondence while providing superior customer service
• Participate in group adjudication sessions and improve claim practices
• Collaborate with Legal to ensure compliance and adherence to state legislative laws

Required Qualifications:

• Minimum of 3 years of eligibility determination experience in long-term care insurance, disability insurance, and/or worker's compensation
• Ability to understand medical conditions and their effect on physical/cognitive function
• Able to interpret and understand complex insurance laws and policies
• Proven problem-solving and business analysis skills
• Demonstrated ability to provide creative solutions to complex problems