Job Description

Job Description

Job Description

Overview : Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefit schedules, and requires excellent judgment, and accurate computation ability, the ability to make routine decisions independently and complex decisions with minimal direction. This position requires commitment to meeting team and departmental goals and a sense of urgency in meeting internal and regulatory time requirements. The appropriate handling of PHI, and excellent communication and customer service skills are required, as well as the ability to foster sound, amicable relationships with internal and external customers. Work involves motivating and being a positive role model for others.

Job Duties

1. Manages assigned claim caseload under general supervision and within normal business hours.

2. Understands and consistently utilizes available resources in determining and managing claim direction

3. Maintains 99% or better overall accuracy, as measured by formal audit and Supervisors work review.

4. Demonstrates a purposeful, steady pursuit (sense of urgency) in meeting Internal and Regulatory time standards, as measured by formal audit, and Supervisors work review.

5. Handles PHI appropriately, adhering to HIPAA regulations and Company standards.

6. Makes routine decisions independently and complex decisions with minimal direction.

7. Attends staff meetings, employee development sessions and works on special projects as assigned.

8. Upholds performance standards

• Performs all job duties in accordance with deadlines established by management
• Performs all job duties in accordance with departmental standards for accuracy, quality and productivity

Prerequisites for the Job

• Minimum 2 years previous experience in long term care or disability claims experience or equivalent.
• College degree preferred.
• Proficiency in oral and written English language communication
• Willingness to work cooperatively with others
• Detail-oriented
• Able to manage multiple tasks and projects under time constraints
• Previous experience using email, Internet, Windows and Microsoft Office and other applicable computer systems
• Well organized
• High school diploma or GED
• Physical and mental requirements for General Office personnel

All candidates must show proof of COVID-19 vaccination upon offer given, or become vaccinated after offer is given.

Job Type: Full-time

Pay: $28.05 - $39.99 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance

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