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Role Description

Responsible for the accurate and timely evaluation, management, and adjudication of Long Term Care claims from initial notification through claim resolution. This role involves:

• Analyzing medical, contractual, and vocational information to determine eligibility for benefits.
• Making informed decisions on claim approvals or denials.
• Ensuring compliance with internal policies and regulatory requirements.
• Effective communication with claimants, employers, and medical professionals.
• Delivering a high-quality customer experience and supporting financial performance and customer retention.

Qualifications

• Analyze and interpret insurance policies and regulations to support accurate Long Term Care claim decisions and benefit calculations.
• Deliver strong customer service and communication through clear verbal and written interactions with claimants and stakeholders.
• Apply analytical thinking and decision-making skills to manage claims effectively.
• Maintain organization, accuracy, and timeliness with strong attention to detail.
• Utilize technical and professional skills including basic medical terminology and Microsoft Office.
• Promote a culture of diversity and inclusion, valuing different ideas and opinions.
• Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

Requirements

• Evaluate and manage Long Term Care claims throughout the claim lifecycle.
• Gather, analyze, and document claim information to determine eligibility, ongoing liability, and benefit payments.
• Maintain strong relationships and communication with claimants, employers, brokers, medical professionals, and internal partners.
• Document claim actions and decisions thoroughly and communicate determinations clearly.
• Ensure compliance and industry awareness by adhering to ERISA and applicable federal/state regulations.

Benefits

• Hourly Wage: $24.00 - $28.00, plus annual bonus opportunity.
• 401(k) plan with a 2% company contribution and 6% company match.
• Work-life balance with vacation, personal time, and paid holidays.