Long Term Care Claims Representative – Payment Servicing
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Job Description
Claims Representative providing customer service for long-term care insurance. Support policyholders through claims process and collaborate with multiple teams.
Responsibilities:
- As an Operations team member, play a crucial role in delivering world-class customer service and capabilities to our policyholders.
- Support the customer centric culture by proactively providing accurate and timely information during the claims process.
- Manage and prioritize a work queue and multiple responsibilities in a fast-paced environment with aggressive deadlines.
- Adhere to Standard Operating Procedures to ensure consistency in claims practices and resolution.
- Make complex claim-payment decisions based on knowledge and policy provisions.
- Apply critical thinking and problem-solving skills to adjudicate claims, process transactions, and process payments.
- Interact with Policy Holders, Powers of Attorney, Agents, Facilities and other entities involved in the claims experience via incoming and outbound calls.
- Collaborate and communicate effectively; seek solutions rather than just identify problems and partner with teams across sites to achieve common goals.
- Occasionally provide training and support to others, including creating training materials, mentoring, and participating in buddy programs.
- Share insights, best practices, and knowledge within Payment Servicing and with supporting departments such as QA, IT, Compliance, Eligibility, and Contact Center.
- Participate in virtual classroom training for the first several months, actively engaging and completing all training requirements.
- Employees are required to be on camera during all training sessions, meetings, and as needed per request.
Requirements:
- Minimum 2 years’ experience in providing professional customer service in a corporate setting, preferably with a medical, financial background, or specifically in Long Term Care.
- High School diploma or military experience
- Ability to successfully complete virtual “classroom” training prior to transitioning into job responsibilities; this requires being on-camera, actively participating, and meeting all training requirements.
- Proficient with Microsoft Office applications (e.g., Word, Excel, Outlook, PowerPoint, Teams, etc.)
- Professional, empathetic demeanor in all interactions, with a strong commitment to serving and supporting customers, particularly within the aging population.
- Your experience or education has provided you with knowledge of medical terminology, diseases/diagnoses, and the ability to understand and interpret contract language, disability processes, nursing home licensing, and rehabilitative requirements.
- You exhibit qualities such as critical thinking, problem-solving, conflict resolution, and collaboration.
- Clear verbal and written communication skills, with the ability to explain insurance products, benefits, and options.
- Ability to toggle between multiple monitors for optimal and efficient productivity
- A dedicated, distraction-free home office set up, including a desk or workstation suitable for full-time remote work.
Benefits:
- Competitive Compensation & Total Rewards Incentives
- Comprehensive Healthcare Coverage
- Multiple 401(k) Savings Plan Options
- Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded!)
- Generous Paid Time Off – Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave
- Disability, Life, and Long Term Care Insurance
- Tuition Reimbursement, Student Loan Repayment and Training & Certification Support
- Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management)
- Caregiver and Mental Health Support Services
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