Claims Adjudicator, Sr. - Long Term Care

Senior Claims Adjudicator, Long Term Care

Responsibilities:

• Responsible for processing claims in a timely manner while analyzing, investigating, and determining benefits.
• Responsible for investigation and determination  of benefits and eligibility of Long Term Care claims
• Obtain required information from various parties in order to complete and update the claimant file.  
• Examine and research claim documentation
• Work closely with Care Managers, Clinicians and Health Care providers to gather facts in determining eligibility, obtaining necessary documentation, and updating claim file.

Education and Experience Requirements:

• Associates degree or equivalent work experience
• Five years Long Term Care and/or Disability claims experience. Critical Illness experience is a plus.
• Must understand processes involving plan of care, chronic illness certifications and benefit determinations in order to accurately adjudicate Long Term Care claims.
• Knowledge and understanding of Long Term Care terminology and definitions. Must have complete understanding of medical terminology with the ability to read and interpret ICD-910, CPT Coding (Current Procedure Terminology) , medical claim forms including HCFA—1500 and UB-04 forms.
• Knowledge of Federal, State and Long Term Care Insurance regulations including ERISA and Prompt Pay.
• Superior organizational skills; especially the ability to handle multiple tasks simultaneously.

LifeSecure is located in Brighton Michigan We are a dynamic growing organization with a rich employee culture and benefit package.  Possible relocation or remote work arrangement may be considered for the right candidate.

Benefits and Perks

• Amazing health benefits (platinum level medical coverage) start on first day
• Wellness reimbursement program
• Competitive salary including an annual incentive bonus program
• Career growth opportunities
• Positive corporate culture
• Casual dress code

EEO