Claims Specialist
illumifin
Date: 3 days ago
City: Remote, Remote
Contract type: Full time
Remote

WE ARE THE KIND OF EMPLOYER YOU DESERVE.
illumifin is an insurance technology company and third-party administrator that designs, develops and delivers tech-enabled insurance policy management software and services that provide unrivaled value for insurers.
We combine insurance insight, operational excellence, and technology innovation to build solutions that deliver high performance and position insurers for the digital world. illumifin is primarily focused on the North American life, long-term care, annuity, and health markets. We believe in true partnerships with our customers and are passionate about insurance.
This position is responsible for adjudicating home and facility-based LTC claims, within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.
Responsibilities
illumifin is an insurance technology company and third-party administrator that designs, develops and delivers tech-enabled insurance policy management software and services that provide unrivaled value for insurers.
We combine insurance insight, operational excellence, and technology innovation to build solutions that deliver high performance and position insurers for the digital world. illumifin is primarily focused on the North American life, long-term care, annuity, and health markets. We believe in true partnerships with our customers and are passionate about insurance.
This position is responsible for adjudicating home and facility-based LTC claims, within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.
Responsibilities
- Reviews internal databases, client guidelines, and policy contract language to adjudicate routine home and facility based LTC claims, in accordance with department processes and standards.
- Queries service providers to obtain licensure information, proof of loss, and claimant dates of service. Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
- Communicated with Claims Examiner II and management on cases requiring special handling.
- Keeps clear and concise documentation of all claim activity within the required databases.
- Meets quality and production metrics as established and communicated by the department.
- Processes requests from the client or from other departmental areas within LTCG.
- Other duties as assigned.
- Associates Degree or equivalent formal training program, or 2 years experience in a medical setting
- 1- 3 years work experience in a claims processing preferred.
- Intermediate level experience with Microsoft Office products.
- Experience working in a geriatric healthcare environment.
- Knowledge of health, long-term care or disability insurance
- Excellent verbal and written communication skills.
How to apply
To apply for this job you need to authorize on our website. If you don't have an account yet, please register.
Post a resumeSimilar jobs
Associate Forester
Forest Carbon Works,
Remote, Remote
$55,000
-
$65,000
per year
6 days ago
Forest Carbon Works, PBC, a subsidiary of Chestnut Carbon, is a nature-based solutions company committed to developing high-quality voluntary carbon offset projects as well as supporting the long-term conservation of American forests and empowering stewardship among family forest owners.We seek to… Conserve standing forests in woodlands throughout America Support the private forest owners who undertake these conservation effortsThese goals are...

Business Operations Analyst
StretchDollar,
Remote, Remote
1 week ago
About UsWe are a mission-driven organization focused on empowering small businesses to offer competitive health benefits, leveling the playing field with larger corporations. At StretchDollar, we simplify the complex world of health insurance by providing a free platform that makes offering employee benefits effortless and accessible.Read our blog to learn more about our mission.OverviewAs the first Business Operations Analyst at...

Experienced Scopist for Legal Transcripts
Tisa Legal Media,
Remote, Remote
1 week ago
Benefits:Flexible scheduleOpportunity for advancementTraining & developmentJoin our dynamic legal transcription team as an Experienced Scopist! We are seeking skilled professionals with a sharp eye for detail and a deep understanding of the legal transcription process. As a leading firm in legal services, we uphold the highest standards of accuracy and efficiency. If you have a proven track record in scoping...
