Registered Nurse Claim Manager

Job Summary

Managing a daily caseload of Long Term Care (LTC) claims, the full-time remote Registered Nurse Claim Manager will evaluate claims for eligibility, educate policyholders on coverage, and communicate with service providers to facilitate claim resolution.

Key Responsibilities

• Determine eligibility of LTC claims by interpreting policy coverage and evaluating provider qualifications
• Educate claimants and their representatives on policy coverage and claim processes while contributing to process improvement initiatives
• Investigate and analyze medical evidence to assess whether policy benefit qualifiers are met, including consulting with physicians and conducting telephonic evaluations

Required Qualifications

• Professional designation as a Registered Nurse (RN) or Licensed Social Worker (LSW) is required
• Preferred experience in LTC, disability, or related claims, with a minimum of 2 years claims experience
• Strong knowledge of claims processes and understanding of medical terminology
• Proficiency in Microsoft Office Products and the ability to quickly learn new system applications
• Demonstrated ability to exercise independent judgment in making sound business decisions related to claims