Ltc Active Specialist - Remote Wi

Employees in this role are eligible for fully remote work after a successful completion of training (approximately six months). The required on site training days are Mondays and Tuesdays (Franklin, WI).

Primary Duties and Responsibilities

• Responds to questions from incoming Insured or representatives’ phone calls and emails regarding requests for information needed for ongoing long-term claim administration.

• Uses extensive claims knowledge in interpreting and analyzing pertinent facts to provide consultative support to proactively educate Insured and their representative on policy language, policy benefits, and claims processing procedures.

• Uses knowledge and empathy to identify, evaluate, and interpret client’s status and needs and provide proactive consultation and recommendations to achieve desired results.

• Communicates both verbally and in writing with Insureds and their representatives, field force, and service providers regarding insured’s change of medical conditions, change of care needs, and/or needs for supplemental medical products and services.

• Assist in determining provider eligibility as it relates to individual Insured’s plan of care by gathering information about Insured’s medical, function and cognitive status.

• Collaborates with providers of care on behalf of Insured to obtain necessary supporting documentation needed to make decisions and process payments.

• Captures and documents claim information accurately in the claim system; creates tasks as required; appropriately pulls work from assigned group planner.

• Process exceptions as they relate to the contracts by interpreting state and contract variations.

• Participate in team meetings, project and committee work as appropriate, including the development of process improvements.

• Support training of new team members, as needed.

• Analyzes eligibility for and approves or denies the payment of active long-term care claims.

Qualifications

• Bachelor’s degree or equivalent combination of education and work experience.

• Healthcare background preferred.

• Previous experience with insurance claims desirable.

• Exhibits empathy and strong client focus and customer service skills.

• Ability to draw logical inferences, problem-solve and apply judgement from explicit and implicit information.

• Eager to learn new information and understand the end-to-end long term care claims process. Seeks out and is open to and obtaining constructive feedback.

• Able to analyze complex information and asks thoughtful questions to understand the situation.

• Able to pivot between different activities and alter approach based on changes in circumstances and/or information.

• Exhibits empathy and strong client focus and customer service skills.

• Enjoys the satisfaction from helping and building relationships with clients and colleagues and demonstrates strong support of team goals.

• Can read, understand, and draw appropriate inferences pertaining to from medical records and/or understand medical terminology, conditions, and circumstances.

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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 additional information relating to location-based pay structures.

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.

FIND YOUR FUTURE

We’re excited about the potential people bring to Northwestern Mutual. You can grow your career here while enjoying first-class perks, benefits, and commitment to diversity and inclusion.

• Flexible work schedules
• Concierge service
• Comprehensive benefits
• Employee resource groups