Care Manager- LTC Claims- LSW or RN

Job description

The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative. WE ARE THE KIND OF EMPLOYER YOU DESERVE. illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases. This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility. RESPONSIBILITIES: 1. Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination. 2. In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific...