LTC Claims Pending Specialist - Remote USA.

Primary Duties and Responsibilities

• Determines the applicability of benefits claimed by interpreting contract provisions, 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, is involves 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
• A bachelor's degree or equivalent combination of education and work experience will be considered
• Experience with insurance claims is desirable
• Strong written and verbal communication skills required
• Strong technology skills required
• Ability to analyze medical records and draw out necessary information for claims processing
• Demonstrates initiative and strong support of team goals and 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.

PLEASE NOTE THE HOURS OF OPERATION FOR THIS ROLE WILL BE 8:30 AM TO 5:00 PM CST. YOU MUST BE ABLE TO WORK THESE CORE HOURS.

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We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more.

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Northwestern Mutual is an equal opportunity employer that welcomes talented individuals of all backgrounds. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.