The nation`s leading administrator of long term care insurance services is looking for youThis is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative.
We are the kind of employer you deserve.
Ltcg is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation`s largest insurersWe also provide clients with unique risk management insight built upon our proprietary long term care databases.
This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility.
1Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representativeIn the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
2In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
3Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
4Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
5Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
6Attend case conferences, internally and with the client, to present claims recommendations.
7Meet quality and production metrics as established and communicated by the department.
8Reviews care coordinator decision recommendations on tax qualified policies.
9Other duties as assigned.
Rn nursing or social work license.
3 years work experience with older adult population.
Intermediate level experience with microsoft office products.
Required to uphold the principles of compliance as outlined in the code of conduct, employee handbook and related policies and proceduresSupports and participates in the mandatory corporate compliance program training initiative on an annual or more frequent basis, as required.
Care planning experience preferred.
Experience with insurance contract interpretation preferred.
Excellent verbal and written communication skills.
Lead level: minimum of one year experience with long term care insurance care management
Equal opportunity employer minorities/women/protected veterans/disabled