Care Coordinator- LTC Claims

illumifin; Eden Prairie (MN); On-site; USD 27,000 - 39,000; Full time

Job summary

illumifin is a leading provider of long-term care claims processing and is seeking a qualified candidate to determine initial and ongoing claimant eligibility. You will review medical records, verify provider credentials, and communicate decisions to claimants and providers, all while ensuring timely processing and adherence to plan language and regulations.

Remote work options may be available; Associates degree or equivalent, 3+ years of claims experience, and MS Office proficiency are

Qualifications

• Associates degree or equivalent training program, or 2 years experience in a medical or insurance environment.
• At least 3 years work experience with claims and insurance contract interpretation.
• Intermediate level experience with Microsoft Office products.

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative.
• Coordinate benefit eligibility assessments when inconsistencies are noted to make a final determination.
• Determine legitimacy and eligibility of service providers by reviewing licensing credentials, regulations, and provider communications.
• Communicate all aspects of the claim benefit determination process verbally and in writing.
• Assist claimants with modifications to their current care plan, including changes in care needs and provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences to present claims recommendations.
• Meet quality and production metrics as established by the department.
• Other duties as assigned.

Education

Associate degree or equivalent training program

Tools

Microsoft Office

Job description

The nation's leading administrator of long term care insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative.

WE ARE THE KIND OF EMPLOYER YOU DESERVE.

illumifin is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases.

This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility.

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.
• Other duties as assigned.

Requirements

Minimum Qualifications

• * Associates Degree or equivalent formal training program, or 2 years experience in a medical or insurance environment.
• * At least 3 years work experience with claims and insurance contract interpretation.
• * Intermediate level experience with Microsoft Office products.

Preferred Qualifications

• * Experience working with healthcare, long-term disability or long term care claims.
• * Familiarity with nursing home and home care service providers and service delivery settings
• * Excellent verbal and written communication skills.

The base pay for this position is targeted at $24/hour depending on experience and qualifications

Location

Remote