Title: LTC Claim Adjuster
The LTC Claim Adjuster is responsible for timely claim adjudication to determine eligibility for benefits under the terms of the insurance policy. The claims process includes investigating, gathering, and reviewing written and verbal documentation specific to the claim that is deemed adequate to determine if a covered loss occurred. Once all necessary documentation has been collected, the adjuster will interpret the information received in conjunction with the terms of the insurance policy to determine the eligibility of the claimant, the provider of services, and if applicable, Restoration of Benefits under the policy resulting in an approval, recommendation for denial, or insufficient evidence determination.
Can process basic claims while still meeting expected production and quality levels.
As a LTC Claim Adjuster, your responsibilities will include:
- Identify and gather claim material necessary to determine initial claimant and provider eligibility as well as Restoration of Benefits decisions.
- Review and interpret claim information, including but not limited to medical records, daily visit notes, benefit eligibility assessments, to formulate an appropriate understanding of claimant condition and care needs
- Investigate, analyze and correlate all relevant material and facts to determine appropriate action based on company records, including claim files, system data and information verbally obtained from the policyholder, legal guardian, and / or provider(s)
- Interpret insurance policy language and apply initial claim processing procedures to both standard and unique claim situations
- Exercise critical thinking and judgment to appropriately conclude benefit eligibility decisions
- Present claim eligibility recommendations to various committees including Claim Review Committee for all denial cases, providing clear rationale for recommendation
- Strong communication skills, written and verbal, to communicate policy provisions, requirements, and claim determinations to claimant and/or legal guardian(s)
- Efficiently navigate workflow, claim management, and record keeping systems
- Effectively manage time to meet department set production goals and maintain quality standards
- Appropriately refer all Tax-Qualified Chronically Ill Certifications to a Licensed Healthcare Practitioner (LHCP) for review and sign-off
- Prioritize claims to provide our customers with a timely decision as well as meet Prompt Pay requirements
- Review up to two providers per two case maximum
Qualified candidates will have:
- Required, High School or equivalent or work related experience
- .Preferred Associate’s Degree
- 2 – 3 Years LTC Claims Experience
CNO Financial Group is a holding company that provides health and life insurance, as well as retirement solutions, to middle-income Americans through its family of established insurance brands: Bankers Life, Colonial Penn and Washington National. Our customers work hard to save for the future, and we help protect their health, income and retirement needs with 3.2 million policies and more than $35 billion in total assets. Our 3,400 associates, 5,000 exclusive agents and 4,000 independent partner agents guide individuals, families and businesses through a lifetime of financial decisions.
We are financially strong and well positioned for continued growth, and we are grounded in our core values of Diversity, Equity & Inclusion (DE&I); Integrity, Customer Focus, Excellence, and Teamwork.
At CNO Financial Group, we’re always looking forward—to the security and stability we help create for our insurance brands’ customers, and the growth we create within our own company. We're looking for ambitious people who want to do more. We'll provide you with opportunities to grow your skills through challenging professional experiences.
If you're looking for a culture that encourages development, helps you reach your potential, and rewards you for your contribution, then CNO Financial Group is right for you. For more information, visit CNOinc.com.
At this time, CNO is not mandating its associates to be vaccinated against COVID-19 as a condition of employment. However, this is an evolving situation, in the future CNO may require its associates to be vaccinated as a condition of employment, subject to reasonable accommodations required by applicable law.
CNO Financial is an Equal Opportunity Employer and Affirmative Action Employer. For more information, please click the following link:
Equal Employment Opportunity is the Law (English)
Equal Employment Opportunity is the Law (Spanish)
Right to Work Poster (English)
Right to Work Poster (Spanish)
As you explore job openings at CNO, please keep in mind that CNO will never ask you to provide payment-related information at any part of the employment application process. And CNO will communicate with you only through emails that are sent from a CNOinc.com or BankerLife.com email address.
If you receive an email purporting to be from CNO that asks for payment-related information or any other personal information, please contact law enforcement and report the email to [email protected]