LTC Claims Eligibility Specialist, Licensed (Remote)

The HT Group; Austin (TX); Hybrid; USD 60,000 - 80,000; Full time

Benefits offered by this job

Competitive Salary & Bonus Program

401(k) with company match

Comprehensive Medical insurance

20+ days of PTO and 10 paid holidays

Flexible Work Options

Health Savings Accounts with company match

Job summary

An established insurance client in Austin is seeking a Remote Long Term Care Claims Eligibility Specialist. This position requires 5+ years of claims management experience and a certification/licensure as LVN, LPN, or LSW. Responsibilities include investigating claims, analyzing documents for coverage, and managing approvals. The role offers competitive salary, bonuses, comprehensive medical insurance, and a flexible working environment. Both remote and hybrid options are available depending on the candidate's location.

Qualifications

• 5+ years of experience in claims management and review.
• Strong technical knowledge of the insurance industry.
• Excellent verbal and written communication skills.

Responsibilities

• Investigate and evaluate claims for coverage and eligibility.
• Analyze relevant documents to support claim decisions.
• Manage short-term and limited approval claims.

Skills

Claims management experience

Strong technical knowledge of claims processing

Excellent communication skills

Ability to work independently

Education

LVN, LPN, LSW certification/license

Job description

Overview

The HT Group has partnered with an established insurance client in Austin, TX looking for a Remote Long Term Care Claims Eligibility Specialist who is experienced, detail-oriented, and customer-focused to review and manage claims of varying complexity. This is a great opportunity for someone looking to grow within a dynamic and mission-driven environment. This is a fully remote position for candidates outside of the Austin, Texas area. For candidates within Austin metroplex it would be a hybrid schedule with 3 days in office.

Only candidates with LVN, LPN, LSW certification/license will be considered.

Responsibilities

• Investigate and evaluate claims for coverage and eligibility
• Analyze relevant documents to support claim decisions
• Establish appropriate Plans of Care based on company guidelines
• Manage short-term and limited approval claims
• Assist with customer complaints and appeals
• Communicate complex claim decisions and coverage details to stakeholders
• Ensure compliance with legal and company claims-handling procedures
• Provide guidance to junior staff and support team leads when needed

Requirements

• 5+ years of experience in claims management and review, preferably in the insurance industry
• LVN, LPN, LSW certification/license required
• Strong technical knowledge of claims processing and policy evaluation
• Excellent verbal and written communication skills, with empathy and professionalism
• Ability to work independently with minimal supervision

Benefits

• Competitive Salary & Target Bonus Program
• Retirement Savings – 401(k) with a company match
• Comprehensive Medical insurance through BlueCross BlueShield of Texas. Company-paid dental, vision, short-term & long-term disability, and life insurance.
• Work-Life Balance – 20+ days of PTO, 10 paid holidays, and paid volunteer time off.
• Flexible Work Options – Hybrid /remote opportunities, wellness programs, and weekly paid lunch for onsite staff.
• Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs.