Remote LTC Claims Manager - Lead Care & Eligibility

illumifin; Eden Prairie (MN); On-site; USD 60,000 - 70,000; Full time

Job summary

illumifin is seeking a qualified care management professional to assess claimant eligibility by reviewing medical records and conducting phone assessments. The role supports provider eligibility checks and care plan changes, with emphasis on compliance and accurate communications.

The position offers remote work and a compensation target of $60,000 depending on experience and qualifications, with opportunity to grow based on performance.

Qualifications

• RN Nursing or Social Work license required.
• 3 years work experience with older adult population.
• Proficiency with Microsoft Office products.
• Annual Compliance Program training required.
• Excellent verbal and written communication skills.
• Lead Level: minimum of one year experience with Long Term Care Insurance Care Management.

Responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments.
• Determine legitimacy and eligibility of service providers by reviewing licensing and regulations.
• Communicate all aspects of the claim benefit determination process in writing and verbally.
• Assist claimants with changes to care plans or providers.
• Monitor reports to ensure timely and appropriate handling of claims.
• Attend case conferences to present claims recommendations.
• Meet quality and production metrics as established by the department.
• Review Care Coordinator recommendations on tax-qualified policies.
• Perform other duties as assigned.

Skills

Excellent verbal and written comms

Microsoft Office proficiency

Attention to detail

Education

RN Nursing license

Social Work license

Tools

Microsoft Office

Job description

illumifin is seeking a qualified care management professional to assess claimant eligibility by reviewing medical records and conducting phone assessments. The role supports provider eligibility checks and care plan changes, with emphasis on compliance and accurate communications.

The position offers remote work and a compensation target of $60,000 depending on experience and qualifications, with opportunity to grow based on performance.