Please Note

Primary Duties and Responsibilities

Performs quantitative and qualitative data analysis to accurately process reimbursement payments for Long Term Care needs.

Uses extensive claims knowledge in interpreting and analyzing pertinent facts to review claims data necessary for accurate financial claims management.

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

Uses knowledge and empathy to identify, evaluate and interpret client’s status and needs and provide proactive resolutions 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 eligibility for payment and decision-making reasoning.

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

Captures and documents claim information from group planner accurately in the claim system.

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 billing eligibility for approval or denial of active long-term care claims.

Qualifications

Bachelors degree or equivalent combination of education and claims work experience will be considered.

Strong analytical and investigative skills both written and verbal.

Able to make sense of information, solve problems and make decisions based on both clear and hidden details.

Eager to learn new information and understand the end-to-end long term care claims process.

Seeks out and is open to obtaining constructive feedback.

Able to analyze complex information and ask 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.

Compensation Range:

Pay Range - Start:

$48,580.00

Pay Range - End:

$90,220.00

Geographic Specific Pay Structure:

We believe in fairness and transparency. It’s why we share the salary range for most of our roles. However, final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. The standard pay structure is listed but if you’re living in California, New York City or other eligible location, geographic specific pay structures, compensation and benefits could be applicable, click here to learn more.

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Northwestern Mutual is an equal opportunity employer who welcomes and encourages diversity in the workforce. We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.