LTC Claims Pending Specialist

🔥 12 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $60.9k - $91.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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Northwestern Mutual

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1869

💸 Finance

Finance • Insurance

Northwestern Mutual is a leading financial services and life insurance company based in Milwaukee, Wisconsin. It offers its clients a broad range of financial planning services including life insurance, disability insurance, long-term care insurance, and personalized investment strategies through its network of financial advisors. Known for its strong corporate culture and commitment to employee development, Northwestern Mutual provides an environment that fosters growth, diversity, and meaningful work opportunities. The company emphasizes flexibility, career growth, and a supportive work culture, making it an attractive place for both new and experienced professionals. Furthermore, Northwestern Mutual prioritizes technology and innovation in financial services, aiming to revolutionize the industry from within.

📋 Description

• Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims • Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine the eligibility of long-term care claims including reimbursement of eligible expenses • Conduct interviews to gather pertinent claim information from the insured or their representative • Answer incoming calls from the field and insureds or their representatives to explain claims status, hypothetical claim situations, and contract provisions • Communicate effectively verbally and in writing with Insureds and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources, is involves negotiation and conflict resolution • Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances • May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements • Work cohesively with team members to meet the goals of the team and division

🎯 Requirements

• Registered Nurse or Social Work license preferred • Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable • A bachelor's degree or equivalent combination of education and work experience will be considered • Experience with insurance claims is desirable • Strong written and verbal communication skills required • Strong technology skills required • Ability to analyze medical records and draw out necessary information for claims processing • Demonstrates initiative and strong support of team goals and results • High degree of analytical skills, personal organization, and time management • Strong client focus and customer service skills • Ability to manage ambiguity and maintain a positive outlook in the face of change • Ability to identify process improvement opportunities.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements • Professional development