LTC Claims Pending Specialist - Remote

Primary Responsibilities

• Determine the applicability of benefits claimed by interpreting contract provisions, state regulations, and using claim knowledge to analyze facts and reach decisions on new and continuing claims, consistent with Northwestern Long Term Care’s claim philosophy.
• Order and review appropriate medical, investigative, service provider, and other information needed to determine the eligibility of long‑term care claims, including reimbursement of eligible expenses.
• Conduct interviews to gather pertinent claim information from the insured or their representative.
• Answer incoming calls from the field and insureds or their representatives to explain claims status, hypothetical claim situations, and contract provisions.
• Communicate effectively verbally and in writing with Insureds, Field Force, medical practitioners, related service providers, attorneys, other insurance companies, and divisional resources, involving negotiation and conflict resolution.
• Preserve Northwestern Long Term Care’s image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
• Serve as a Subject Matter Expert (SME) on project and committee work, including the development of process improvements.
• Work cohesively with team members to meet the goals of the team and division.

• Registered Nurse or Social Work license preferred; alternatively, a healthcare background or a minimum of 3+ years of long‑term care insurance experience.
• A bachelor’s degree or an equivalent combination of education and work experience.
• Experience with insurance claims is desirable.
• Strong written and verbal communication skills.
• Strong technology skills.
• Ability to analyze medical records and extract necessary information for claims processing.
• Initiative, strong support of team goals, and result orientation.
• High degree of analytical skills, personal organization, and time management.
• Client focus and customer service skills.
• Ability to manage ambiguity and maintain a positive outlook in the face of change.
• Capability to identify process improvement opportunities.

Hours of Operation: 8:30 AM to 5:00 PM CST. Candidates must be able to work these core hours.

Compensation Range: $60,880.00 to $91,320.00. Geographic specific pay structures may apply for eligible locations.

Northwestern Mutual is an equal‑opportunity employer that welcomes talented individuals of all backgrounds. We are committed to creating and maintaining an inclusive environment where each employee can contribute ideas, seek challenges, assume leadership, and focus on meeting and exceeding business and personal objectives.