Job Description

Please Note:

• Primary Duties and Responsibilities

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

• Uses extensive claims knowledge in interpreting and analyzing pertinent facts to provide consultative support to proactively educate the Insured and their representative on policy language, policy benefits, and claims processing procedures.

• Uses knowledge and empathy to identify, evaluate, and interpret the client’s status and needs and provide proactive consultation 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 change of medical conditions, change of care needs, and/or needs for supplemental medical products and services.

• Assist in determining provider eligibility as it relates to the individual Insured’s plan of care by gathering information about the Insured’s medical, functional, and cognitive status.

• Collaborates with providers of care on behalf of the Insured to obtain necessary supporting documentation needed to make decisions and process payments.

• Captures and documents claim information accurately in the claim system; creates tasks as required; appropriately pulls work from the assigned group planner.

• 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 eligibility for and approves or denies the payment of active long-term care claims.

Qualifications

• Bachelor’s degree or equivalent combination of education and work experience.

• Healthcare background preferred.

• Previous experience with insurance claims is desirable.

• Exhibits empathy and strong client focus and customer service skills.

• Ability to draw logical inferences, problem-solve, and apply judgment from explicit and implicit information.

• Eager to learn new information and understand the end-to-end long-term care claims process. Seeks out and is open to and 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.

• Can read, understand, and draw appropriate inferences from medical records and/or understand medical terminology, conditions, and circumstances.

PLEASE NOTE THE HOURS OF OPERATION FOR THIS ROLE WILL BE 8:30 AM TO 5:00 PM CST. YOU MUST BE ABLE TO WORK THESE CORE HOURS.

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Compensation Range:

Pay Range - Start:

$56,640.00

Pay Range - End:

$84,960.00

Geographic Specific Pay Structure:

Structure 110:

$62,320.00 USD - $93,480.00 USD

Structure 115:

$65,120.00 USD - $97,680.00 USD

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 that welcomes talented individuals of all backgrounds. 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.