Care Coordinator -LTC Claims

illumifin Corporation; Minnesota; Presencial; USD 55 000 - 75 000; Tempo integral

Resumo da oferta

illumifin Corporation, a leading provider of insurance services, is seeking a Claims Eligibility Specialist in Minnesota. You will join a culture that promotes respect, integrity, learning and initiative.

This role focuses on gathering and reviewing requirements to determine initial and ongoing claimant and provider eligibility, reviewing medical records, and communicating the determination process to claimants and providers.

Qualificações

• Experience reviewing medical records to determine eligibility.
• Ability to interpret plan language and regulatory requirements.
• Strong communication skills to explain conclusions to claimants and providers.
• Comfort with handling confidential information and maintaining accuracy.

Responsabilidades

• Assess claimant eligibility by reviewing medical records from providers and conducting phone assessments with the claimant or legal representative.
• Determine legitimacy and eligibility of service providers by reviewing licensing credentials and state regulations.
• Communicate, both verbally and in writing, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their care plan, including changes in care needs or providers.
• 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 by the department.
• Other duties as assigned.

Conhecimentos

Analytical thinking

Attention to detail

Verbal & written communication

Descrição da oferta de emprego

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.