Care Manager- LTC Claims RN or LSW

illumifin; Minnesota; On-site; USD 60,000 - 80,000; Full time

Job summary

LTCG in Minnesota is seeking an experienced Claims Eligibility Reviewer to join our team. You will assess claimant eligibility by reviewing medical records, coordinating certifications, and communicating outcomes to clients and providers.

You will work with plan language, licensing credentials, and state regulations to determine service legitimacy, support case conferences, and help maintain quality and timely processing of claims.

Qualifications

• Experience reviewing claimant eligibility from medical records.
• Ability to coordinate certifications and review licensing credentials.
• Strong written and verbal communication skills.

Responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments.
• Determine legitimacy of service providers by reviewing licensing credentials and regulations.
• Communicate clearly all aspects of the claim benefit determination process.
• Assist claimants with changes to care plans and providers.
• Monitor reports to ensure timely handling of claims.
• Attend case conferences to present claims recommendations.
• Meet quality and production metrics as required.

Skills

Medical records review

Phone assessments

Claims processing

Communication skills

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.

LTCG 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.
• Reviews Care Coordinator decision recommendations on tax qualified policies.
• Other duties as assigned.