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Job Description:

Summary

This role will require coming into the Rochester, NY office.

The LTC Claims Administration Specialist performs timely and accurate data-entry and transactional processing in the claims administration system. The incumbent processes and adjudicates Long-Term Care claims.

Essential Accountabilities:

Level I

• In accordance with established departmental procedures, corporate policies and member contracts, will process, enter, and adjudicate insurance claims, request needed information, and work closely with other required internal departments to meet policy criteria.

• Responds to internal inquiries associated with simple claims transactions including those that do not require contract interpretation and/or lengthy historical audits. Sorts incoming mail, scans and indexes all incoming and outgoing correspondences from the LTC Benefits Department using the digital record retention system; and daily check-run processing.

• Performs accurate, timely data-entry and transactional processing of nursing home, assisted living facility and home care claims.

• Obtains telephone verification from LTC providers and maintains professional interaction with Insureds and their families. Assures all incoming and outgoing correspondences are processed in accordance with record retention policy.

• Participates in the training needed to learn regulations, systems, and procedures while skills and initiating actions to accurately fulfill all requirements of the job.

• Ensures compliance in meeting or exceeding the Company production standards for time service and quality.

• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and behaviors.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

• Regular and reliable attendance is expected and required.

• Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

• Resolves moderately complex claims processing and claims history audits.

• Manages a caseload while working closely with assigned Personal Care Advisors to ensuring service expectations and metrics are successfully meet.

• Accurately interprets policies and processes LTC claims, ensuing all regulations and organizational metrics are met.

• Completes mail process either by entering, sorting, distributing, or indexing items independently.

Level III (in addition to Level II Accountabilities)

• Performs complex claims processing, claims history audits and policy interpretation, ensuring all regulations and organizational metrics are met.

• Executes assigned tasks timely and accurately, identifying and analyzing forms and processes for errors and implement necessary revisions.

• Trains and mentors other team members in all areas of the department including but not limited to claim payment, audits, and mail entry.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

• Associate degree. In lieu of a degree, three (3) years of data entry or customer service experience required.

• Able to learn and operate internal claims system for entry and processing.

• Ability to efficiently resolve simple claims transactions, through navigating screens on the computer, referencing written policies and procedures and adhering to the most current business requirements.

• Excellent communication skills and demonstrated abilities in dealing effectively with all levels of internal and external customers.

• Ability to perform self-directed and deliver deadline driven work.

• Basic computer skills required, including the ability to navigate Microsoft Office Suite. Ability to work between multiple programs and applications at the same time.

• Strong attention to detail, organizational, reasoning, and problem-solving skills.

• Ability to work effectively as a part of a team.

Level II (In addition to Level I qualifications)

• One (1) year of experience in a Level I Claims Specialist role.

• Adept at multi-tasking to efficiently resolve moderately complex claims processing and claims history audits.

• Capable of adequately interpreting policy language as needed.

• Able to work independently to meet assigned monthly metrics as directed by management.

• Demonstrates ability to perform all generally assigned specialized job tasks, with limited assistance, within the specialized units.

Level III (In addition to Level II qualifications)

• Two (2) years of experience in a Level II Claims Specialist role.

• Ability to multi-task efficiently to resolve a wide variety of complex claims transactions.

• Advanced level reasoning and problem-solving skills.

• Demonstrates comprehensive knowledge and understanding of all policies to act as a resource for Level I and Level II colleagues.

• Experience with training or mentoring colleagues.

• Self-directed with the ability to deliver job tasks and projects within a deadline.

Physical Requirements:

• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.

• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level 1: Grade N2: Minimum $18.22 - Maximum $23.89

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. https://lifethc.sharepoint.com/sites/HumanCapitalManagement/SitePages/Talent-Acquisition-%26-Onboarding.aspx#hiring-process All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.