LTC Claims Eligibility Specialist, Licensed (Remote)

Overview The HT Group has partnered with an established insurance client in Austin, TX looking for a Remote Long Term Care Claims Eligibility Specialist who is experienced, detail-oriented, and customer-focused to review and manage claims of varying complexity. This is a great opportunity for someone looking to grow within a dynamic and mission-driven environment. This is a fully remote position for candidates outside of the Austin, Texas area. For candidates within Austin metroplex it would be a hybrid schedule with 3 days in office. Only candidates with LVN, LPN, LSW certification/license will be considered. Responsibilities Investigate and evaluate claims for coverage and eligibility Analyze relevant documents to support claim decisions Establish appropriate Plans of Care based on company guidelines Manage short-term and limited approval claims Assist with customer complaints and appeals Communicate complex claim decisions and coverage details to stakeholders Ensure compliance with legal and company claims-handling procedures Provide guidance to junior staff and support team leads when needed Requirements 5+ years of experience in claims management and review, preferably in the insurance industry LVN, LPN, LSW certification/license required Strong technical knowledge of claims processing and policy evaluation Excellent verbal and written communication skills, with empathy and professionalism Ability to work independently with minimal supervision Benefits Competitive Salary & Target Bonus Program Retirement Savings – 401(k) with a company match Comprehensive Medical insurance through BlueCross BlueShield of Texas. Company-paid dental, vision, short-term & long-term disability, and life insurance. Work-Life Balance – 20+ days of PTO, 10 paid holidays, and paid volunteer time off. Flexible Work Options – Hybrid /remote opportunities, wellness programs, and weekly paid lunch for onsite staff. Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs. #J-18808-Ljbffr