Long Term Care Claims Representative – Servicing

Position Title

Long Term Care Claims Representative – Payment Servicing

This position is available to remote applicants residing in states/locations under Eastern or Central Standard Time:
Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin.

During training, hours will be 8:00 AM-5:00 PM EST. Once training is complete, the regular schedule will be 8:00 AM-5:00 PM EST. Schedule may adjust slightly in the future based on business needs. Candidates are expected to have consistent, reliable and predictable attendance during the virtual classroom training and upon successful completion of training to support the needs of our customers.

• Manage and prioritize a work queue and multiple responsibilities in a fast-paced environment with aggressive deadlines.
• Adhere to Standard Operating Procedures to ensure consistency in claims practices and resolution.
• Make complex claim-payment decisions based on knowledge and policy provisions.
• Apply critical thinking and problem-solving skills to adjudicate claims, process transactions, and process payments.
• Interact with Policy Holders, Powers of Attorney, Agents, Facilities and other entities involved in the claims experience via incoming and outbound calls.
• Collaborate and communicate effectively; you will seek solutions rather than just identify problems and will partner with teams across sites to achieve common goals.
• Occasionally provide training and support to others, including creating training materials, mentoring, and participating in buddy programs.
• Share insights, best practices, and knowledge within Payment Servicing and with supporting departments such as QA, IT, Compliance, Eligibility, and Contact Center.
• Maintain the required flexibility to perform tasks outside of the role as needed, with provided training and guidance.
• Participate in virtual classroom training for the first several months, actively engaging and completing all training requirements. Employees are required to be on camera during all training sessions, meetings, and as needed per request.
• While working remotely, employees will provide a safe and secure workspace that is free of distractions, and must retain a stable and secure internet service provider with the bandwidth and speed to maintain network connectivity (50 mbps).

• Minimum 2 years’ experience in providing professional customer service in a corporate setting, preferably with a medical, financial background, or specifically in Long Term Care.
• High School diploma or military experience.
• Ability to successfully complete virtual classroom training prior to transitioning into job responsibilities; this requires being on-camera, actively participating, and meeting all training requirements.
• Proficient with Microsoft Office applications (e.g., Word, Excel, Outlook, PowerPoint, Teams, etc.).
• Professional, empathetic demeanor in all interactions, with a strong commitment to serving and supporting customers, particularly within the aging population.
• Your experience or education has provided you with knowledge of medical terminology, diseases/diagnoses, and the ability to understand and interpret contract language, disability processes, nursing home licensing, and rehabilitative requirements.
• You exhibit qualities such as critical thinking, problem-solving, conflict resolution, and collaboration. Clear verbal and written communication skills, with the ability to explain insurance products, benefits, and options.
• Ability to toggle between multiple monitors for optimal and efficient productivity.
• A dedicated, distraction‑free home office set up, including a desk or workstation suitable for full‑time remote work.

• Associate or Bachelor’s Degree.
• Prior experience in the insurance industry.
• Familiarity with HIPPA requirements.