[Hiring] Care Coordinator @illumifin

Role Description

This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility.

• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
• In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
• Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
• Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
• Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
• Attend case conferences, internally and with the client, to present claims recommendations.
• Meet quality and production metrics as established and communicated by the department.
• Other duties as assigned.

Qualifications

• Associates Degree or equivalent formal training program, or 2 years experience in a medical or insurance environment.
• At least 3 years work experience with claims and insurance contract interpretation.
• Intermediate level experience with Microsoft Office products.

Requirements

• Experience working with healthcare, long-term disability or long term care claims.
• Familiarity with nursing home and home care service providers and service delivery settings.
• Excellent verbal and written communication skills.

Benefits

• The base pay for this position is targeted at $24/hour depending on experience and qualifications.