Care Specialist

Care Specialist

Provide personalized service and product knowledge through correspondence to and from Long-Term Care customers, servicing agents, and business partners. Provide written and verbal responses to customer inquiries and policyowner administration requests originating from multiple channels such as telephone calls, correspondence, and e-mail. Promotes the value of Long-Term Care products and represents the company's mission and values. Deliver customer assistance in a friendly, personalized way that builds trustworthy, long lasting customer relationships.

Determine claims eligibility and manage cost effective care planning for Long Term Care (LTC) policyowners. Coordinate with other LTC Department staff to provide personalized customer service, by accurately administering LTC claims and clearly communicating policy language.

Starting Pay Rate: $21.75 Full Time: Full Time Standard Hours Per Week: Monday - Friday, 40 hours/week Work Schedule: Shift starts between 6:00 AM and 9:00 AM MT Schedule Type: In-Office

Eligibility Review - Conduct review of all relevant documents (care plans, assessments, medical records, etc.) to determine eligibility for benefits. Conduct reassessments as needed to determine continued eligibility.

Processes, Procedures, and Guidelines - Contribute to the improvement of written processes, procedures, and guidelines for care coordination, ensuring consistency with other LTC Department functioning. This includes initiating improvement in efficiency using better methods and automated systems.

Communication - Communicate and explain care planning to customers, care providers, agents, and SILAC staff, by showing consistency with evidence from provider records and functional assessments. Coordinate and communicate with other SILAC leadership, medical consultants, auditors, and other industry professionals.

Other Administrative Functions - Assist as requested with tasks and projects such as claim appeals, legal disputes, and revision of forms and documents.

Report to and perform other work or projects as directed by the L&H Eligibility Manager.

Job Requirements

• High school diploma, GED, or any combination of education, professional training, or work experience that demonstrates ability to do the job.
• Ability to accurately assess policyowner needs and create individualized care plans.
• Experience in communicating professionally, patiently, and clearly in speech and in writing.
• Ability to research and logically consider details from many sources, and to bring them together to support a conclusion.
• Experience using PC applications such as MS Word, Excel, Teams, and Outlook.
• Detail-oriented with the ability to complete tasks with accuracy and in a timely manner.
• Demonstrated ability to work independently while managing workload and meeting time-sensitive deadlines.

• Geriatric client experience.
• Long Term Care, disability, or other insurance claims experience.
• Insurance experience in cost containment.
• Knowledge of state regulations and requirements, Anti-Money Laundering procedures and identifying potential fraud or elderly abuse situations.

BENEFITS:

• Medical Plans, including FSA and HSA
• Dental and Vision
• 401(k) (Roth and Traditional)
• Pet Insurance
• Parental Leave
• Paid Time and Sick Time off
• 10 Paid Holidays and 1 Birthday Pay
• Paid Volunteer Time
• College Tuition Reimbursement

SILAC Insurance Company