LTC Claims Care Manager

Job Summary

Responsible for determining claimant and provider eligibility, the full-time LTC Claims Care Manager will gather and review requirements, assess medical records, and communicate claim determinations while ensuring compliance with quality metrics.

Key responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments
• Determine legitimacy of service providers by reviewing licensing credentials and state regulations
• Assist claimants with modifications to care plans and monitor claims processing reports

Required qualifications

• Experience in healthcare or insurance claims processing
• Knowledge of medical records and provider eligibility requirements
• Ability to communicate effectively in verbal and written formats
• Familiarity with case management and care coordination
• Understanding of quality and production metrics in a claims environment