Long Term Care Benefit Claim Specialist

Responsible for the accurate and timely evaluation, management, and adjudication of Long Term Care claims from initial notification through claim resolution. This role involves analyzing medical, contractual, and vocational information to determine eligibility for benefits, making informed decisions on claim approvals or denials, and ensuring compliance with internal policies and regulatory requirements. The position requires effective communication with claimants, employers, and medical professionals while delivering a high-quality customer experience and supporting financial performance and customer retention. You must have current working experience with Long Term Care specific claims adjudication.

WHAT WE CAN OFFER YOU:

• Hourly Wage: $24.00 - $27.00, plus annual bonus opportunity.
• 401(k) plan with a 2% company contribution and 6% company match.
• Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
• Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.

WHAT YOU'LL DO:

• Evaluate, adjudicate and manage Long Term Care claims throughout the claim lifecycle, partnering with management to make informed decisions based on claim facts, policy provisions, and supporting documentation.
• Gather, analyze, and document claim information to determine eligibility, ongoing liability, and benefit payments while ensuring accurate financial calculations and compliance with contract terms.
• Maintain strong relationships and communication with claimants, employers, brokers, medical professionals, and internal partners to support effective claim resolution and a high-quality customer experience.
• Document claim actions and decisions thoroughly and communicate determinations, status updates, and benefit changes clearly through written correspondence and direct outreach.
• Ensure compliance and industry awareness by adhering to ERISA and applicable federal/state regulations while staying current on industry trends, legislation, and internal processes.

WHAT YOU’LL BRING:

• Seasoned Long Term Care Claims adjudication and analyzation skills
• Proven ability to analyze and interpret insurance policies and regulations to support accurate Long Term Care claim decisions and benefit calculations.
• Deliver strong customer service and communication through clear verbal and written interactions with claimants and stakeholders.
• Apply analytical thinking and decision-making skills to manage claims effectively while developing greater independence and critical thinking.
• Maintain organization, accuracy, and timeliness with strong attention to detail, the ability to meet deadlines, and adaptability in a changing environment.
• Utilize technical and professional skills including basic medical terminology, Microsoft Office and internal systems, and the ability to manage claims over extended durations while ensuring fair and consistent claim handling.
• You promote a collaborative culture, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
• Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

PREFERRED:

• College degree or equivalent industry experience

We value unique experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!

If you have questions about your application or the hiring process, email our Talent Acquisition area at . Please allow at least one week from time of applying if you are checking on the status.

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Salary: C20 | Pay Scale: 100 C20 - Hourly

Originally posted on Himalayas