Care Specialist

SILAC Insurance Company•Salt Lake City, UT

9d•Onsite

About The Position

The Care Specialist determines claims eligibility and manages cost-effective care planning for Long-Term Care (LTC) policyowners. The role coordinates with other LTC Department staff to provide personalized customer service, accurately administer claims, and clearly communicate policy language. It also provides personalized service and product knowledge to LTC customers, servicing agents, and business partners through written and verbal responses to inquiries and policyowner administration requests received by telephone, correspondence, and email. The Care Specialist promotes the value of LTC products and represents the company’s mission and values while building trustworthy, lasting customer relationships. This is a full-time, in-office position scheduled Monday through Friday for 40 hours per week. The shift starts between 6:00 AM and 9:00 AM Mountain Time. Starting pay is $21.75 per hour. The role reports to the L&H Eligibility Manager.

Requirements

High school diploma, GED, or a combination of education, professional training, or work experience demonstrating ability to perform the job.
Ability to accurately assess policyowner needs and create individualized care plans.
Experience communicating professionally, patiently, and clearly in speech and writing.
Ability to research and logically consider details from multiple sources and bring them together to support a conclusion.
Experience using PC applications such as Microsoft Word, Excel, Teams, and Outlook.
Detail-oriented, with the ability to complete tasks accurately and in a timely manner.
Demonstrated ability to work independently, manage workload, and meet time-sensitive deadlines.

Nice To Haves

Geriatric client experience.
Long-Term Care, disability, or other insurance claims experience.
Insurance experience in cost containment.
Knowledge of state regulations and requirements, Anti-Money Laundering procedures, and identifying potential fraud or elderly abuse situations.

Responsibilities

Review relevant documents, including care plans, assessments, and medical records, to determine benefit eligibility; conduct reassessments as needed to determine continued eligibility.
Contribute to improving written processes, procedures, and guidelines for care coordination, ensuring consistency with other LTC Department functions.
Identify ways to improve efficiency through better methods and automated systems.
Communicate and explain care planning to customers, care providers, agents, and SILAC staff, supporting communications with evidence from provider records and functional assessments.
Coordinate and communicate with SILAC leadership, medical consultants, auditors, and other industry professionals.
Assist with tasks and projects as requested, including claim appeals, legal disputes, and revision of forms and documents.
Perform other work or projects as directed by the L&H Eligibility Manager.
Provide written and verbal responses to customer inquiries and policyowner administration requests received through telephone calls, correspondence, and email.
Provide personalized customer service and product knowledge to Long-Term Care customers, servicing agents, and business partners.