LTC Active Specialist – Billing

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

📋 Description

• Conducts both quantitative and qualitative analyses of data to ensure accurate processing of reimbursement payments for Long Term Care requirements.

• Leverages extensive claims knowledge to interpret and analyze relevant details for reviewing claims data, essential for effective financial claims management.

• Addresses inquiries from incoming phone calls and emails from insured individuals or their representatives concerning requests for information vital for ongoing long-term claim administration.

• Utilizes knowledge and empathy to assess, evaluate, and interpret the client's status and needs, providing proactive solutions and recommendations to achieve desired outcomes.

• Communicates effectively, both verbally and in writing, with insured individuals and their representatives, field personnel, and service providers regarding eligibility for payments and the rationale behind decisions.

• Assists in determining provider eligibility in relation to the individual insured’s plan of care by gathering pertinent information about the insured’s medical, functional, and cognitive status.

• Collaborates with care providers on behalf of the insured to secure necessary supporting documentation required for decision-making and payment processing.

• Accurately captures and documents claim information within the claims system; creates tasks as needed and pulls work appropriately from the assigned group planner.

• Processes exceptions related to contracts by interpreting variations in state regulations and contract terms.

• Engages in team meetings, project initiatives, and committee work as appropriate, including the development of process enhancements.

• Provides support in training new team members as required.

• Evaluates eligibility for and approves or denies payments for active long-term care claims.

⛳️ Requirements

• Bachelor’s degree or equivalent in business, accounting, actuarial sciences, or mathematics is required.

• Background in insurance claims is preferred.

• Strong analytical and investigative abilities.

• Capable of drawing logical conclusions, solving problems, and applying judgment based on both explicit and implicit information.

• Willingness to learn new information and comprehend the complete long-term care claims process.

• Open to receiving constructive feedback and actively seeks it out.

• Proficient in analyzing complex information and asking insightful questions to gain a clear understanding of the situation.

• Able to adapt to different activities and modify approaches based on changes in circumstances and/or information.

• Demonstrates empathy along with strong client focus and customer service skills.

🏝️ Benefits

• Health insurance

• Retirement plans

• Paid time off

• Flexible work arrangements

• Professional development opportunities