Care Eligibility Specialist - Claims & Care Planning

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

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.