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LTC Claims Pending Specialist
1 month ago
Primary Duties and responsibilities
- Determines the applicability of benefits claimed by interpreting contract provisions, and state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy.
- Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine the eligibility of long-term care claims including reimbursement of eligible expenses.
- Conduct interviews to gather pertinent claim information from the insured or their representative.
- Answer incoming calls from the field and insureds or their representatives to explain claims status, hypothetical claim situations, and contract provisions.
- Communicate effectively verbally and in writing with Insureds and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources involving 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.
- Work cohesively with team members to meet the goals of the team and division.
- Qualifications
- Registered Nurse or Social Work license preferred
- Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable
- Bachelor's degree or equivalent combination of education and work experience will be considered
- Experience with insurance claims desirable
- Strong written and verbal communication skills required
- Strong technology skills required
- Demonstrates 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 manage ambiguity and maintain a positive outlook in the face of change
- Ability to identify process improvement opportunities.
Compensation Range:
Pay Range - Start:
$51,170.00
Pay Range - End:
$95,030.00
Northwestern Mutual pays on a geographic-specific salary structure and placement in the salary range for this position will be determined by a number of factors including the skills, education, training, credentials and experience of the candidate; the scope, complexity as well as the cost of labor in the market; and other conditions of employment. At Northwestern Mutual, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. Please note that the salary range listed in the posting is the standard pay structure. Positions in certain locations (such as California) may provide an increase on the standard pay structure based on the location. Please click here for additiona l information relating to location-based pay structures.
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We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age or status as a protected veteran, or any other characteristic protected by law.
If you work or would be working in California, Colorado, New York City, Washington or outside of a Corporate location, please click here for information pertaining to compensation and benefits.
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