Remote LTC Claims Specialist

illumifin Corporation; Eden Prairie (MN); Remote; USD 27,000 - 39,000; Full time

Job summary

illumifin Corporation is seeking a Claims Eligibility Specialist to gather and review requirements to determine claimant and provider eligibility. You will assess medical records, conduct phone assessments, and coordinate benefit eligibility when needed.

Responsibilities include reviewing provider licensing, state regulations, and communicating the results to claimants and clients, with a focus on accuracy and timely processing in a remote setting.

Qualifications

• Associates Degree or equivalent formal 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 a benefit eligibility assessment if inconsistencies are noted.
• Determine legitimacy and eligibility of service providers by reviewing licensing credentials and state regulations.

Skills

Claims processing experience

Microsoft Office

Medical/insurance environment

Verbal and written communication

Education

Associate degree or equivalent training

2 years experience in a medical/insurance environment

Tools

Microsoft Office

Job description

illumifin Corporation is seeking a Claims Eligibility Specialist to gather and review requirements to determine claimant and provider eligibility. You will assess medical records, conduct phone assessments, and coordinate benefit eligibility when needed.

Responsibilities include reviewing provider licensing, state regulations, and communicating the results to claimants and clients, with a focus on accuracy and timely processing in a remote setting.