Senior LTC Claims & Eligibility Lead

illumifin; Minnesota; On-site; USD 60,000 - 80,000; Full time

Job summary

LTCG in Minnesota is seeking an experienced Claims Eligibility Reviewer to join our team. You will assess claimant eligibility by reviewing medical records, coordinating certifications, and communicating outcomes to clients and providers.

You will work with plan language, licensing credentials, and state regulations to determine service legitimacy, support case conferences, and help maintain quality and timely processing of claims.

Qualifications

• Experience reviewing claimant eligibility from medical records.
• Ability to coordinate certifications and review licensing credentials.
• Strong written and verbal communication skills.

Responsibilities

• Assess claimant eligibility by reviewing medical records and conducting phone assessments.
• Determine legitimacy of service providers by reviewing licensing credentials and regulations.
• Communicate clearly all aspects of the claim benefit determination process.
• Assist claimants with changes to care plans and providers.
• Monitor reports to ensure timely handling of claims.
• Attend case conferences to present claims recommendations.
• Meet quality and production metrics as required.

Skills

Medical records review

Phone assessments

Claims processing

Communication skills

Job description

LTCG in Minnesota is seeking an experienced Claims Eligibility Reviewer to join our team. You will assess claimant eligibility by reviewing medical records, coordinating certifications, and communicating outcomes to clients and providers.

You will work with plan language, licensing credentials, and state regulations to determine service legitimacy, support case conferences, and help maintain quality and timely processing of claims.