What are the responsibilities and job description for the Claims Specialist position at LTCG?
The nation's leading administrator of long term care insurance services is looking for YOU. This 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 insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases.
This position is responsible for adjudicating home and facility-based LTC claims, within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.
RESPONSIBILITIES
1. Reviews internal databases, client guidelines, and policy contract language to adjudicate routine home and facility based LTC claims, in accordance with department processes and standards.
2. Queries service providers to obtain licensure information, proof of loss, and claimant dates of service. Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
3. Communicated with Claims Examiner II and management on cases requiring special handling.
4. Keeps clear and concise documentation of all claim activity within the required databases.
5. Meets quality and production metrics as established and communicated by the department.
6. Processes requests from the client or from other departmental areas within LTCG.
7. Other duties as assigned.
Minimum Qualifications
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 insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases.
This position is responsible for adjudicating home and facility-based LTC claims, within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.
RESPONSIBILITIES
1. Reviews internal databases, client guidelines, and policy contract language to adjudicate routine home and facility based LTC claims, in accordance with department processes and standards.
2. Queries service providers to obtain licensure information, proof of loss, and claimant dates of service. Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
3. Communicated with Claims Examiner II and management on cases requiring special handling.
4. Keeps clear and concise documentation of all claim activity within the required databases.
5. Meets quality and production metrics as established and communicated by the department.
6. Processes requests from the client or from other departmental areas within LTCG.
7. Other duties as assigned.
Minimum Qualifications
- Associates Degree or equivalent formal training program, or 2 years experience in a medical setting
- 1- 3 years work experience in a claims processing preferred.
- Intermediate level experience with Microsoft Office products.
- Experience working in a geriatric healthcare environment.
- Knowledge of health, long-term care or disability insurance
- Excellent verbal and written communication skills.
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