Active LTC Benefits Spec

Primary Duties and responsibilities

• Analyzes eligibility for and approves or denies the payment of active long-term care claims (analyzes and processes client bills, establishes new independent providers, prepares for annual review, and other transactions applicable to active claims).
• Assist in determining provider eligibility as it relates to individual insureds’ plan of care by gathering information about the insured’s medical function and cognitive status.
• Determines applicability of benefits claimed by interpreting state and contract variations.
• Responds to questions from incoming insureds or representative’s phone calls and emails regarding requests for information needed for ongoing long term claim administration Communicates both verbally and in writing with Insureds and their representatives, Field Force, medical practitioners and related service providers, attorneys, other insurance companies, and divisional resources which involve negotiation and conflict resolution.
• Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
• May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements.
• Update standard work as requested.
• Support co-workers to meet the goals of the team and division.
• Discuss any identified process improvements ideas with leadership to determine feasibility.
• This role involves managing a queue of incoming phone calls, which includes direct client interactions a minimum of 16 hours per week.
  

Qualifications

• Healthcare background desirable
• Bachelor's degree or equivalent combination of education and work experience will be considered
• Experience with Long Term Care or insurance claims desirable
• Strong written and verbal communication skills required
• Strong technology skills required
• Demonstrated initiative and strong support of team results
• High degree of analytical skills, personal organization, and time management
• Strong client focus and customer service skills
• Ability to deal with ambiguity and maintain a positive outlook in the face of change
• Ability to identify process improvement opportunities.

Compensation Range:

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Geographic Specific Pay Structure:

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We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, clickhere to learn more.

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Northwestern Mutual is an equal opportunity employerwho welcomes and encourages diversity in the workforce. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.