Remote Care Coordinator - LTC Claims & Eligibility

illumifin; Eden Prairie (MN); On-site; USD 27,000 - 39,000; Full time

Job summary

illumifin is a leading provider of long-term care claims processing and is seeking a qualified candidate to determine initial and ongoing claimant eligibility. You will review medical records, verify provider credentials, and communicate decisions to claimants and providers, all while ensuring timely processing and adherence to plan language and regulations.

Remote work options may be available; Associates degree or equivalent, 3+ years of claims experience, and MS Office proficiency are

Qualifications

• Associates degree or equivalent training program, or 2 years experience in a medical or insurance environment.
• At least 3 years work experience with claims and insurance contract interpretation.
• Intermediate level experience with Microsoft Office products.

Responsibilities

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative.
• Coordinate benefit eligibility assessments when inconsistencies are noted to make a final determination.
• Determine legitimacy and eligibility of service providers by reviewing licensing credentials, regulations, and provider communications.
• Communicate all aspects of the claim benefit determination process verbally and in writing.
• Assist claimants with modifications to their current care plan, including changes in care needs and provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences to present claims recommendations.
• Meet quality and production metrics as established by the department.
• Other duties as assigned.

Education

Associate degree or equivalent training program

Tools

Microsoft Office

Job description

illumifin is a leading provider of long-term care claims processing and is seeking a qualified candidate to determine initial and ongoing claimant eligibility. You will review medical records, verify provider credentials, and communicate decisions to claimants and providers, all while ensuring timely processing and adherence to plan language and regulations.

Remote work options may be available; Associates degree or equivalent, 3+ years of claims experience, and MS Office proficiency are