LTC Specialist - Remote

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 to interpret and analyze pertinent facts to provide consultative support and 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 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.
• Assists 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.
• Processes exceptions as they relate to the contracts by interpreting state and contract variations.
• Participates in team meetings, project and committee work as appropriate, including the development of process improvements.
• Supports training of new team members, as needed.
• Analyzes eligibility for and approves or denies the payment of active long-term care claims.

• 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 obtains 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.
• 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.

Hours of operation for this role: 8:30 AM to 5:00 PM CST. You must be able to work these core hours.

Compensation Range:
Pay Range – Start: $56,640.00, End: $84,960.00
Geographic Specific Pay Structure:
Structure 110: $62,320.00 – $93,480.00
Structure 115: $65,120.00 – $97,680.00

Northwestern Mutual is an equal opportunity employer that welcomes talented individuals of all backgrounds.