[Hiring] Long Term Care Benefit Claim Specialist @Careers Mutual Of Omaha

Role Description

Responsible for the accurate and timely evaluation, management, and adjudication of Long Term Care claims from initial notification through claim resolution. This role involves:

• Analyzing medical, contractual, and vocational information to determine eligibility for benefits.
• Making informed decisions on claim approvals or denials.
• Ensuring compliance with internal policies and regulatory requirements.
• Effective communication with claimants, employers, and medical professionals.
• Delivering a high-quality customer experience and supporting financial performance and customer retention.

You must have current working experience with Long Term Care specific claims adjudication.

Qualifications

• Seasoned Long Term Care Claims adjudication and analyzation skills.
• Proven ability to analyze and interpret insurance policies and regulations.
• Strong customer service and communication skills.
• Analytical thinking and decision-making skills.
• Strong attention to detail and organizational skills.
• Technical skills including basic medical terminology and proficiency in Microsoft Office.
• Ability to work remotely with access to a high-speed internet connection.

Requirements

• Evaluate, adjudicate, and manage Long Term Care claims throughout the claim lifecycle.
• Gather, analyze, and document claim information to determine eligibility and benefit payments.
• Maintain strong relationships and communication with claimants, employers, brokers, and medical professionals.
• Document claim actions and decisions thoroughly.
• Ensure compliance with ERISA and applicable federal/state regulations.
• Stay current on industry trends, legislation, and internal processes.

Benefits

• Hourly Wage: $24.00 - $27.00, plus annual bonus opportunity.
• 401(k) plan with a 2% company contribution and 6% company match.
• Work-life balance with vacation, personal time, and paid holidays.