Position Summary:

Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefits schedules and requires excellent judgment and accurate computation ability. Work also involves extensive personal contact with others and/or can be of personal or sensitive nature. Work may involve motivating or influencing others. Recognizes the special needs of elderly claimants and their families, and acts to fulfill those needs in and courteous manner. Fostering sound, amicable relationships with individuals or entities inside and outside the Company is necessary.

Primary Responsibilities:

1. Accurately interprets Long Term Nursing Care policy language and executes accordingly.
2. Makes eligibility recommendations for Supervisor consideration.
3. Accurately documents for claim direction and updates as needed.
4. Assesses various types of new information to support claim direction.
5. Recommends Nurse Care Manager Visits, Medical Consultant Reviews, Surveillance, Independent Medical Evaluations when required.
6. Timely handling of mail and correspondence to meet/exceed company standards.
7. Communicates with claimants/representatives via phone, e-mail, letter or fax.
8. Handles incoming calls and returns voice mail messages timely.
9. Manages daily reports to assure productive claim handling.
10. Ability to work in an environment that embraces Best Practices.

Prerequisites for the Job:

• Previous long term care or disability claims experience or equivalent.
• 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 Windows and Microsoft Office and other applicable computer systems.
• Well organized.

Long Term Disability Claim Experience

Worker's Compensation Claim Experience

Property and Casualty Claim Experience

Short Term Disability Clam Experience

Auto Personal Injury Claim Experience

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