Claims Specialist

illumifin is an insurance technology company and third-party administrator that designs, develops and delivers tech-enabled insurance policy management software and services that provide unrivaled value for insurers.

We combine insurance insight, operational excellence, and technology innovation to build solutions that deliver high performance and position insurers for the digital world. illumifin is primarily focused on the North American life, long-term care, annuity, and health markets. We believe in true partnerships with our customers and are passionate about insurance.

This position is responsible for adjudicating home and facility-based LTC claims, within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives, and providers.

Responsibilities

• Reviews internal databases, client guidelines, and policy contract language to adjudicate routine home and facility based LTC claims, in accordance with department processes and standards.
• Queries service providers to obtain licensure information, proof of loss, and claimant dates of service. Verifies that provider or care is appropriate base on the claimant's diagnosis and is in accordance with contract language and government regulations regarding healthcare providers.
• Communicated with Claims Examiner II and management on cases requiring special handling.
• Keeps clear and concise documentation of all claim activity within the required databases.
• Meets quality and production metrics as established and communicated by the department.
• Processes requests from the client or from other departmental areas within illumifin.
• Other duties as assigned.
  
  

Requirements

Minimum Qualifications

• Associates Degree or equivalent formal training program, or 2 years experience in a medical setting
• 1- 3 years work experience in a claims processing preferred.
• Intermediate level experience with Microsoft Office products.
  
  

Preferred Qualifications

• Experience working in a geriatric healthcare environment.
• Knowledge of health, long-term care or disability insurance
• Excellent verbal and written communication skills.