Remote Long-Term Care Claims Eligibility Specialist

Continental General; Austin (TX); Hybrid; USD 30,000 - 39,000; Full time

Job summary

Continental General is seeking a Claims Eligibility Specialist - Clinical in a hybrid role. You will review and manage long term care claims, determine eligibility, and collaborate with a team to ensure accurate processing and a positive customer experience.

This is a full-time, hourly, non-exempt position with 3 days in-office and open to remote candidates. The role requires 5+ years in claims, a related degree, and strong communication.

Qualifications

• 5+ years of related experience in claims management.
• Bachelor’s degree in LVN/LPN/LSW or related field or equivalent experience.
• Strong written and verbal communication with empathy.
• Performs work with limited supervision.

Responsibilities

• Investigates and supports cases of varying complexity.
• Reviews eligibility for long term care claims.
• Establishes Plan of Care per guidelines.
• Manages short-term/limited approval claims.
• Assists with complaints/appeals and communicates outcomes.
• Ensures compliance with applicable statutes, regulations, and policies.
• Works with Team Lead(s) and provides back-up support.
• Guides lower-level positions and other areas.
• Performs other duties as assigned.

Skills

Empathy communication

Claims analysis

Regulatory knowledge

Team guidance

Education

Bachelor's degree or related field

Job description

Continental General is seeking a Claims Eligibility Specialist - Clinical in a hybrid role. You will review and manage long term care claims, determine eligibility, and collaborate with a team to ensure accurate processing and a positive customer experience.

This is a full-time, hourly, non-exempt position with 3 days in-office and open to remote candidates. The role requires 5+ years in claims, a related degree, and strong communication.