LTC Active Specialist - Remote USA.

Northwestern Mutual • Remote-Wisconsin, WI

1d • $56,640 - $97,680 • Remote

About The Position

This role is responsible for managing ongoing long-term care claims. The specialist will respond to inquiries from insureds and representatives, provide consultative support on policy language and benefits, and analyze claim information to make payment decisions. The position requires strong analytical, communication, and problem-solving skills, with a focus on client service and empathy. The specialist will also collaborate with healthcare providers, document claim information accurately, and process exceptions based on state and contract variations. Participation in team meetings, process improvement initiatives, and training new team members is also expected.

Requirements

• Bachelor’s degree or equivalent combination of education and work experience.
• Exhibits empathy and strong client focus and customer service skills.
• Ability to draw logical inferences, problem-solve, and apply judgment from explicit and implicit information.
• Eager to learn new information and understand the end-to-end long-term care claims process. Seeks out and is open to and obtaining constructive feedback.
• Able to analyze complex information and ask thoughtful questions to understand the situation.
• Able to pivot between different activities and alter approach based on changes in circumstances and/or information.
• Enjoys the satisfaction from helping and building relationships with clients and colleagues, and demonstrates strong support of team goals.
• Can read, understand, and draw appropriate inferences from medical records and/or understand medical terminology, conditions, and circumstances.
• Must be able to work core hours of 8:30 AM to 5:00 PM CST.

Nice To Haves

• Healthcare background preferred.
• Previous experience with insurance claims is desirable.

Responsibilities

• Responds to questions from incoming Insureds or representatives’ phone calls and emails regarding requests for information needed for ongoing long-term claim administration.
• Uses extensive claims knowledge in interpreting and analyzing pertinent facts to provide consultative support to proactively educate the Insured and their representative on policy language, policy benefits, and claims processing procedures.
• Uses knowledge and empathy to identify, evaluate, and interpret the client’s status and needs and provide proactive consultation and recommendations to achieve desired results.
• Communicates both verbally and in writing with Insureds and their representatives, field force, and service providers regarding insured’s change of medical conditions, change of care needs, and/or needs for supplemental medical products and services.
• Assist in determining provider eligibility as it relates to the individual Insured’s plan of care by gathering information about the Insured’s medical, functional, and cognitive status.
• Collaborates with providers of care on behalf of the Insured to obtain necessary supporting documentation needed to make decisions and process payments.
• Captures and documents claim information accurately in the claim system; creates tasks as required; appropriately pulls work from the assigned group planner.
• Process exceptions as they relate to the contracts by interpreting state and contract variations.
• Participate in team meetings, project and committee work as appropriate, including the development of process improvements.
• Support training of new team members, as needed.
• Analyzes eligibility for and approves or denies the payment of active long-term care claims.

Benefits

• The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level