Claims Manager
Long Term Care Group, Inc.3.6
Remote
Job description

CLAIMS MANAGER

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.

The Claims Manager position is responsible for evaluation and rendering eligibility decisions on home and facility based LTC claims (standalone and hybrid), chronic illness riders and critical illness within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.

CLAIMS MANAGER RESPONSIBILITIES:

  • Reviews internal databases, client guidelines, and policy contract language to evaluate routine home and facility-based claims, in accordance with department processes and standards.
  • Communicate clearly and routinely with claimants, representatives, third parties, physicians, and other health care providers as needed.
  • Demonstrated interviewing skills which include the professional judgment to probe as necessary to uncover underlying concerns from the claimant or representative.
  • Queries service providers to obtain licensure information, proof of loss, and dates of service. Verifies that provider and/or care is appropriate base on the claimant’s diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
  • Keeps clear and concise documentation of all claim activity within the required databases.
  • Creates plans of care and refers for review and Chronic Illness Certification as appropriate.
  • Uses time effectively to achieve expected productivity and efficiency.
  • Demonstrates ability to prioritize workload. Performs work accurately and efficiently under deadline pressures.
  • Always provides prompt, courteous and excellent customer service to internal and external customers
  • Demonstrates effective communication skills, level of attentiveness, and use of appropriate lines of authority. Promptly shares accurate and complete information to others who need it, based on HIPAA and legal documents regarding release.
  • Attends or is responsible for information provided at meetings and through other organizational channels.
  • Maintains appropriate organizational confidentiality.
  • Communicates with other team members and management on cases as needed.
  • Meets quality and production metrics as established and communicated by the department. Works independently and seeks assistance as appropriate.

CLAIMS MANAGER REQUIREMENTS

  • Certifications Required: Current, valid and unrestricted Registered Nurse (RN) or Social Work license.
  • 4-year Degree or equivalent formal training program.
  • 2 years’ experience in medical, insurance or risk management setting
  • 1-year work experience in a claim processing preferred.
  • Intermediate level experience with Microsoft Office products.

LTCG values diversity and is committed to providing an environment of mutual respect. LTCG is an Equal Opportunity Employer (EOE/AA) and participates in E-Verify. LTCG will not discriminate in its employment and employment-related decisions against any applicant or employee based on age, race, gender, creed, religion, national origin, disability, marital status, covered veteran status, sexual orientation, status with respect to public assistance, membership or activity on a local commission, or any other characteristic protected under state, federal, or local law.

Job Type: Full-time

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Employee discount
  • Flexible spending account
  • Health insurance
  • Health savings account
  • Life insurance
  • Paid time off
  • Referral program
  • Vision insurance

Schedule:

  • 8 hour shift
  • Monday to Friday

Experience:

  • Claims: 2 years (Preferred)

License/Certification:

  • RN (Preferred)
  • Licensed Social Worker (Preferred)

Work Location: Remote

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Company details

Headquarters

11010 Prairie Lakes Dr, Eden Prairie, MN 55344

Employee

1001 to 5000

Revenue

$100M to $500M (USD)

Industry

Insurance

Company Description
LTCG is a leading provider of business process outsourcing for the insurance industry. The nation's largest insurers rely on our unparalleled expertise to help manage their complex long-term care portfolios and maximize financial performance. We also provide clients with advanced risk management insight built upon our unique and proprietary long-term care underwriting and claims databases. LTCG has more than 1.4 million long-term care policies currently under its management, representing nearly 20% of all active policies. We serve over 50 national carriers, including every one of the top 10 insurers in the long-term care market. Our experienced management team, which has worked together for years, includes some of the most recognized and respected leaders in the long-term care industry. And our information systems have been developed specifically to support the intricacies of this unique market. To learn more, visit www.ltcg.com.
Company ratings
  • Overall
    3.6
  • Company & Benefits
    3.0 / 5
  • Culture & Values
    2.9 / 5
  • Career Opportunities
    2.6 / 5
  • Work/Life Balance
    3.1 / 5
  • Senior Management
    2.8 / 5
Company reviews
"Great place to work! "
Former EmployeeCustomer Service Representative
I really enjoyed my time while I worked there. I loved that it was remote. The trainers were very hands on. Great communication between supervisor and team, flexible schedule, awesome leadership and great benefits!
Pros:

"Good work life balance, work from home"
Former EmployeeSupervisor
I did have a good worklife balance. Able to work from home. Not a lot of opportunity for advancement. Coworkers were friendly and available to assist, answer questions when needed.

"Incompetent upper management. Oppressive workload. Toxic, cutthroat culture."
Former Employee
Lots of fingerpointing by upper management. They accept no responsibility or make any attempt to rectify known risks or issues. Employees are disposable. Environment is disparaging and disrespectful. Turnover is a major issue but no efforts are taken to address or mitigate it. Glad to have my life back after leaving!

"Customer care professional "
Former EmployeeCustomer Care Specialist
It’s okay, not much advancement with the company, definitely a good place to start. The pay doesn’t go up unless you’re promoted I assume so not much to fight for