Care Manager- LTC Claims- LSW or RN

illumifin • Eden Prairie, MN

5h

About The Position

illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers and providing clients with unique risk management insight. This position is responsible for gathering and reviewing requirements to determine initial and ongoing claimant and provider eligibility.

Requirements

• RN Nursing or Social Work license.
• 3 years work experience with older adult population.
• Intermediate level experience with Microsoft Office products.
• Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required.

Nice To Haves

• Care planning experience preferred.
• Experience with insurance contract interpretation preferred.
• Excellent verbal and written communication skills.

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
• In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
• Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences, internally and with the client, to present claims recommendations.
• Meet quality and production metrics as established and communicated by the department.
• Reviews Care Coordinator decision recommendations on tax qualified policies.
• Other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 251-500 employees