Job Title: |
Appeals Specialist - Long Term Care Claims
Reviews LTC appeals of long-term care benefit denials by completing a fair, independent assessment and thorough review of the file and determining the benefit denial by evaluating plan provisions, and medical and functional information. Identifies questionable aspects to the claim to determine the need for additional information and requesting the information when appropriate.
Makes decisions based on available information and writes custom, clear, concise letters with appropriate details to insureds, their representatives or attorneys regarding decision in a timely manner.
Identifies opportunities for improvement to process, or feedback to business partners for training opportunities.
- Manages caseload of complex cases; applies specialized training/knowledge to the assessment of cases
- Reviews medical records, and analyzes data to make benefit appeal determination
- Follows established claim policies and practices to resolve issues.
- Registered or Licensed Practical Nurse with at least 5 years experience; or without nursing degree , must have a inimum of 5 years experience with medical / clinical benefit decision making role in insurance industry.
- Proven assessment skills and professional judgment
- Ability to evaluate many and varied factors to arrive at accurate decisions
- Excellent verbal and written communication skills
- Demonstrated ability to compose professional and concise letters
- Experience with writing detailed letters to customers and their representatives
- Experience with telephonic communication with clients as needed.
- Ability to manage workload with minimal supervision / excellent time management skills
- Computer literacy, especially Microsoft Office, and typing skills.
Five to Seven Years
Bachelors Degree Preferred
Number of Openings
Equal Employment Opportunity
MetLife is proud to be an equal opportunity/affirmative action employer. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.
How To Apply
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Don't accuse New England Life Insurance of a regional bias. The company, which operates as New England Financial, provides insurance and...