LTC Claims Active Specialist

Northwestern Mutual

14d

About The Position

This role involves managing a queue of incoming phone calls, which includes direct client interactions a minimum of 16 hours per week. Responds to questions from incoming insureds or representative’s phone calls and emails regarding requests for information needed for ongoing long term claim administration Communicates both verbally and in writing with Insureds and their representatives, Field Force, medical practitioners and related service providers, attorneys, other insurance companies, and divisional resources which involve negotiation and conflict resolution. Analyzes eligibility for and approves or denies the payment of active long-term care claims (analyzes and processes client bills, establishes new independent providers, prepares for annual review, and other transactions applicable to active claims). Assist in determining provider eligibility as it relates to individual insureds’ plan of care by gathering information about the insured’s medical function and cognitive status. Determines applicability of benefits claimed by interpreting state and contract variations. Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances. May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements. Update standard work as requested. Support co-workers to meet the goals of the team and division. Discuss any identified process improvements ideas with leadership to determine feasibility. Ability to work varying shifts between the hours of 7am CT - 5pm CT based on business needs.

Requirements

Strong written and verbal communication skills required
Strong technology skills required
Demonstrated initiative and strong support of team results
High degree of analytical skills, personal organization, and time management
Strong client focus and customer service skills
Ability to deal with ambiguity and maintain a positive outlook in the face of change
Ability to identify process improvement opportunities.

Nice To Haves

Experience with Long Term Care or insurance claims desirable
Healthcare background desirable
Bachelor's degree or equivalent combination of education and work experience will be considered

Responsibilities

Manages a queue of incoming phone calls, which includes direct client interactions a minimum of 16 hours per week.
Responds to questions from incoming insureds or representative’s phone calls and emails regarding requests for information needed for ongoing long term claim administration
Communicates both verbally and in writing with Insureds and their representatives, Field Force, medical practitioners and related service providers, attorneys, other insurance companies, and divisional resources which involve negotiation and conflict resolution.
Analyzes eligibility for and approves or denies the payment of active long-term care claims (analyzes and processes client bills, establishes new independent providers, prepares for annual review, and other transactions applicable to active claims).
Assist in determining provider eligibility as it relates to individual insureds’ plan of care by gathering information about the insured’s medical function and cognitive status.
Determines applicability of benefits claimed by interpreting state and contract variations.
Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements.
Update standard work as requested.
Support co-workers to meet the goals of the team and division.
Discuss any identified process improvements ideas with leadership to determine feasibility.
Ability to work varying shifts between the hours of 7am CT - 5pm CT based on business needs.