This is a fully remote position, open to applicants in Florida.

📋 Description

• Evaluate and adjudicate long-term care claims along with policy provisions for either payment or denial.

• Process payments or issue denials for invoices related to long-term care claims.

• Identify, assess, and apply long-term care claim product features and relevant policy benefits.

• Achieve or surpass production and quality targets approved by management.

• Provide accurate, timely, and professional responses to both external and internal inquiries regarding benefits, eligibility, claim payments, denials, and explanations of benefits.

• Manage inbound calls related to claims.

• Maintain an up-to-date understanding of company services and claims, as well as administrative and imaging software systems.

• Operate in accordance with HIPAA, fraud prevention, confidentiality, and private health information regulations.

• Execute additional tasks as assigned.

⛳️ Requirements

• Familiarity with company services relevant to the business segment.

• Knowledge of company claims, administrative, and imaging software systems, including INSPRO and Microsoft applications.

• Capability to operate in compliance with HIPAA, fraud prevention, confidentiality, and private health information regulations.

• Proficiency in accurately and promptly reviewing long-term care claims and policy provisions.

• Understanding of long-term care claim product features, such as waiver of premium, waiting period, assignment of benefits, credits, and other relevant policy benefits.