LTC Claims Pending Specialist

Northwestern Mutual

13d

About The Position

Primary Duties and responsibilities Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy. Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine eligibility of long-term care claims including reimbursement of eligible expenses. Conduct interviews to gather pertinent claim information from insured or their representative. Answer incoming calls from the field and insureds or their representatives to explain status of claim, hypothetical claim situations, and contract provisions. Communicate effectively 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. 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. Work cohesively with team members to meet the goals of the team and division

Requirements

• Registered Nurse or Social Work license preferred
• Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable
• Bachelor's degree or equivalent combination of education and work experience will be considered
• Experience with insurance claims desirable
• Strong written and verbal communication skills required
• Strong technology skills required
• Demonstrates 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.

Responsibilities

• Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy.
• Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine eligibility of long-term care claims including reimbursement of eligible expenses.
• Conduct interviews to gather pertinent claim information from insured or their representative.
• Answer incoming calls from the field and insureds or their representatives to explain status of claim, hypothetical claim situations, and contract provisions.
• Communicate effectively 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.
• 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.
• Work cohesively with team members to meet the goals of the team and division

What This Job Offers

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