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LTC Benefits Pending Specialist

At Northwestern Mutual, we are strong, innovative and growing. We invest in our people. We care and make a positive difference.

Principal Duties/Accountabilities:

  • Investigates, analyzes and approves or denies and long-term care claims. Uses claim knowledge in interpreting and analyzing pertinent facts to reach a claim decision.

  • Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine eligibility of long-term care claims including reimbursement of eligible expenses.

  • Determines applicability of benefits claimed by interpreting state and contract variations.

  • Communicates both verbally and in writing with Insureds and their representatives, Field Force, medical practitioners and related service providers, attorneys, other insurance companies, and divisional resources which involve negotiation and conflict resolution.

  • Preserves Northwestern Long-Term Care’s image and reputation in the approval or denial of benefits despite difficult and delicate circumstances.

  • Support of training of new team members, as needed.

  • Project and committee work as a Subject Matter Expert (SME) as appropriate, including the development of process improvements.

Requirements:

  • Social Work License or RN License preferred but not required, healthcare background desirable

  • Bachelor’s degree or equivalent combination of education and work experience will be considered

  • Experience with insurance claims desirable

  • Demonstrated initiative and strong support of team results

  • High degree of leadership skills including personal organization and time management

  • Strong client focus and customer service skills

  • Ability to take care of ambiguity and maintain a positive outlook in the face of change

  • Experience with process improvements and the development of procedures and processes.

  • Outstanding organization skills, ability to multi-task, and excellent prioritization skills vital

  • Strong verbal and written communication skills

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This job is not covered by the existing Collective Bargaining Agreement.

Required Certifications:

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We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, disability, age or status as a protected veteran, or any other characteristic protected by law.


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