Senior Care Eligibility & Claims Specialist

illumifin Corporation; Minnesota; On-site; USD 55,000 - 75,000; Full time

Job summary

illumifin Corporation, a leading provider of insurance services, is seeking a Claims Eligibility Specialist in Minnesota. You will join a culture that promotes respect, integrity, learning and initiative.

This role focuses on gathering and reviewing requirements to determine initial and ongoing claimant and provider eligibility, reviewing medical records, and communicating the determination process to claimants and providers.

Qualifications

• Experience reviewing medical records to determine eligibility.
• Ability to interpret plan language and regulatory requirements.
• Strong communication skills to explain conclusions to claimants and providers.
• Comfort with handling confidential information and maintaining accuracy.

Responsibilities

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

Skills

Analytical thinking

Attention to detail

Verbal & written communication

Job description

illumifin Corporation, a leading provider of insurance services, is seeking a Claims Eligibility Specialist in Minnesota. You will join a culture that promotes respect, integrity, learning and initiative.

This role focuses on gathering and reviewing requirements to determine initial and ongoing claimant and provider eligibility, reviewing medical records, and communicating the determination process to claimants and providers.