Care Coordinator- LTC Claims

illumifin; Minnesota; On-site; USD 45,000 - 65,000; Full time

Job summary

illumifin is seeking a Claim Eligibility Reviewer to assess claimant eligibility by reviewing medical records and conducting phone assessments. The role includes coordinating benefit eligibility determinations and ensuring provider legitimacy through licensing credentials and state regulations.

The candidate will communicate results effectively, support modifications to care plans, and monitor reports to meet quality and production metrics within a collaborative team.

Qualifications

• Experience reviewing medical records to determine eligibility or benefits.
• Ability to perform phone assessments with claimants or representatives.
• Familiarity with provider licensing and state regulations is a plus.

Responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments.
• Determine legitimacy of service providers via licensing credentials and state regulations.
• Communicate all aspects of the claim benefit determination process in writing and verbally.

Skills

Medical records review

Eligibility determination

Phone assessments

Provider licensing review

Regulatory compliance

Written/verbal communication

Care plan modification

Data reporting

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.