LTC Active Specialist - Remote WI

at  Northwestern Mutual

AT NORTHWESTERN MUTUAL, WE ARE STRONG, INNOVATIVE AND GROWING. WE INVEST IN OUR PEOPLE. WE CARE AND MAKE A POSITIVE DIFFERENCE.

Employees in Southeastern WI 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).

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.

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.

GROW YOUR CAREER WITH A BEST-IN-CLASS COMPANY THAT PUTS OUR CLIENT’S INTERESTS AT THE CENTER OF ALL WE DO. GET STARTED NOW!

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.