Licensed Claims Manager - Clinician

Job Summary

A company is looking for a Claim Manager I - Clinician (Remote).

Key Responsibilities

• Interpret LTC policy coverage and assess eligibility based on claims guidelines
• Evaluate provider qualifications and maintain accurate data in the claims administrative system
• Consult with claimants' physicians and conduct phone evaluations to monitor progress and care needs

Required Qualifications

• Professional designation as a Registered Nurse (RN) or Licensed Social Worker (LSW) with Long-Term Care experience
• Preferred experience in LTC, disability, or related claims
• Minimum of 2 years claims experience is preferred
• Strong knowledge of claims processes and medical terminology
• Proficiency in Microsoft Office Products and adaptability to new system applications