Northwestern Mutual

LTC Claims Pending Specialist - Remote USA.

Northwestern Mutual$60K — $105K *
US-AnywhereRemote in Wisconsin, US
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • Registered Nurse or Social Work license preferred
  • 3+ years of long-term care insurance experience or healthcare background
  • Bachelor's degree or equivalent combination of education and experience
  • Desirable experience with insurance claims
  • Strong written and verbal communication skills
  • High degree of analytical skills and personal organization
  • Client-focused with strong customer service skills

Responsibilities

  • Determine applicability of benefits by interpreting contracts and regulations
  • Order and review medical and investigative information for claims eligibility
  • Conduct interviews to gather claim information from insureds or their representatives
  • Answer incoming calls to explain claims status and contract provisions
  • Communicate effectively with various stakeholders including insureds, lawyers, and service providers
  • Maintain the company's image while managing benefit approvals or denials
  • Participate in project and committee work as a Subject Matter Expert

Benefits

  • 8:30 AM to 5:00 PM CST working hours
  • Eligibility for involvement in process improvement projects
  • Opportunity to work within a collaborative team environment
  • Ongoing training and development in claims processing
  • Potential to work with a diverse range of stakeholders in the healthcare field.
Full Job Description
Primary Duties and Responsibilities
  • Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy.
  • Orders and reviews 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 and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources, is involves negotiation and conflict resolution.
  • Preserves Northwestern Long Term Care's image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.
  • May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements.
  • Work cohesively with team members to meet the goals of the team and division.
  • Qualifications
  • Registered Nurse or Social Work license preferred
  • Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable
  • A bachelor's degree or equivalent combination of education and work experience will be considered
  • Experience with insurance claims is desirable
  • Strong written and verbal communication skills required
  • Strong technology skills required
  • Ability to analyze medical records and draw out necessary information for claims processing
  • Demonstrates initiative and strong support of team goals and results
  • High degree of analytical skills, personal organization, and time management
  • Strong client focus and customer service skills
  • Ability to manage ambiguity and maintain a positive outlook in the face of change
  • Ability to identify process improvement opportunities.


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.

Compensation Range:

Pay Range - Start:
$60,880.00

Pay Range - End:
$91,320.00

Geographic Specific Pay Structure:

Structure 110:
$66,960.00 USD - $100,440.00 USD

Structure 115:

$70,000.00 USD - $105,000.00 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.

About Northwestern Mutual

Northwestern Mutual has been helping people and businesses achieve financial security for more than 160 years. Through a holistic planning approach, Northwestern Mutual combines the expertise of its financial professionals with a personalized digital experience and industry-leading products to help its clients plan for what's most important. Northwestern Mutual delivers financial security to millions with life, disability income and long-term care insurance, annuities, and brokerage and advisory services. The company manages billion of dollars of investments owned by its clients and held or managed through its wealth management and investment services businesses. Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company (NM), Milwaukee, WI (life and disability insurance, annuities, and life insurance with long-term care benefits) and its subsidiaries. Subsidiaries include Northwestern Mutual Investment Services, LLC (NMIS) (securities), broker-dealer, registered investment adviser, member FINRA and SIPC; the Northwestern Mutual Wealth Management Company® (NMWMC) (fiduciary and fee-based financial planning services), federal savings bank; and Northwestern Long Term Care Insurance Company (NLTC) (long-term care insurance).

Northwestern Mutual Careers

Joining Northwestern Mutual presents a unique opportunity to be part of a team that is dedicated to empowering personal and professional growth, innovation, and leadership in the financial services industry. As a company renowned for its commitment to excellence and a culture that values diversity and inclusion, Northwestern Mutual offers unparalleled job opportunities for both seasoned professionals and those at the start of their careers.

Work You’ll Do

At Northwestern Mutual, we believe in building strong relationships not only with our clients but also among our team members. By joining our team, you will collaborate with some of the most talented professionals in the industry, all united in their commitment to leadership and innovation. Our employees are equipped with top-tier benefits and diversity training that ensure their career journey is both rewarding and inclusive.

Explore Professional Growth and Development

Northwestern Mutual is committed to fostering an environment where career growth is not just a possibility but a priority. With a variety of positions available, from financial representatives to internships for budding professionals, our company is a place where your skills and passion can thrive. We provide extensive training programs and leadership development opportunities that prepare you for success in your current role and beyond.

Innovative Work Environment

Our team at Northwestern Mutual is at the forefront of integrating cutting-edge technology and innovative financial strategies to provide exceptional service to our clients. This focus on innovation is not just about staying current; it's about leading the way in the financial sector. Employees at all levels are encouraged to contribute ideas and take initiative, driving the company forward as a leader in the financial industry.

Be Part of Our Diverse and Inclusive Team

Diversity and inclusion are more than just buzzwords at Northwestern Mutual; they are integral to our company culture and business strategy. We are committed to creating a workplace where all employees can flourish. Our diversity training programs are designed to enhance understanding and foster an inclusive environment for all team members.

Networking and Career Advancement

Networking within Northwestern Mutual opens doors to expansive career advancement opportunities. We encourage our employees to engage in internal networking events, which often lead to mentorship and further career development. Whether you are looking to enhance your resume, prepare for an interview, or step into a leadership role, Northwestern Mutual provides the resources and support to help you achieve your professional goals.

Join Our Team

Search open positions that match your skills and interests. We are looking for passionate, curious, and solution-driven team players who are ready to take their career to the next level. Explore the job opportunities and internships available at Northwestern Mutual and find out how you can contribute to our legacy of innovation and leadership.

Stay Connected

Keep up to date with career tips, insider perspectives, and industry-leading insights you can put to use today—all from the people who work here. Personalize your subscription to receive job alerts, latest news, and insider tips tailored to your preferences. Discover the exciting and rewarding career opportunities that await at Northwestern Mutual.

SEARCH NORTHWESTERN MUTUAL JOBS

Join us and start your journey at Northwestern Mutual today, where your career is nurtured, your skills are honed, and your achievements are celebrated.
Learn more about Northwestern Mutual
Size
7,000 employees
Industry

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