LTC Claims Pending Specialist - (October 2025 Start Date- 6 Roles Are Available) - Remote USA.

Employment Type

Full time

Location & Schedule

• Employees in Southeastern WI are eligible for fully remote work after a successful completion of training (approximately six months).
• Required on-site training days are Mondays and Tuesdays (Franklin, WI).
• This role will start in early October 2025.
• The recruitment process will be approximately 2-6 weeks from application.
• Hours of Operation: 8:30 AM to 5:00 PM CST. You must be able to work these core hours.

Primary Duties and Responsibilities

• Determines the applicability of benefits claimed by interpreting contract provisions, state regulations, and uses claim knowledge in interpreting and analyzing facts to reach claim decisions on new and continuing claims, consistent with Northwestern Long Term Care's claim philosophy.
• Orders and reviews appropriate medical, investigative, service provider, and other information needed to determine the eligibility of long-term care claims including reimbursement of eligible expenses.
• Conducts interviews to gather pertinent claim information from the insured or their representative.
• Answers incoming calls from the field and insureds or their representatives to explain claims status, hypothetical claim situations, and contract provisions.
• Communicates effectively verbally and in writing with Insureds and their representatives, Field Force, medical practitioners, and related service providers, attorneys, other insurance companies, and divisional resources, involving 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.
• May be called upon for project and committee work as a Subject Matter Expert (SME), including the development of process improvements.
• Works cohesively with team members to meet the goals of the team and division.

Qualifications

• Registered Nurse or Social Work license preferred.
• Healthcare background OR minimum 3+ years of long-term care insurance experience highly desirable.
• A bachelor's degree or equivalent combination of education and work experience will be considered.
• Experience with insurance claims is desirable.
• Strong written and verbal communication skills required.
• Strong technology skills required.
• Ability to analyze medical records and draw out necessary information for claims processing.
• Demonstrates initiative and strong support of team goals and results.
• High degree of analytical skills, personal organization, and time management.
• Strong client focus and customer service skills.
• Ability to manage ambiguity and maintain a positive outlook in the face of change.
• Ability to identify process improvement opportunities.

Compensation Range

• Pay Range - Start: $52,220.00
• Pay Range - End: $96,980.00
• Geographic Specific Pay Structure:
  • 170 - Structure 110 (Exempt): $57,470.00 USD - $106,730.00 USD
  • 170 - Structure 115 (Exempt): $60,060.00 USD - $111,540.00 USD
• Final salaries are based on a number of factors, including the skills and experience of the candidate; the current market; location of the candidate; and other factors uncovered in the hiring process. Geographic specific pay structures, compensation and benefits could be applicable if you are living in California, New York City or other eligible locations.

About Northwestern Mutual

• Grow your career with a best-in-class company that puts our clients' interests at the center of all we do.
• Northwestern Mutual is an equal opportunity employer who welcomes and encourages diversity in the workforce.
• We are committed to creating and maintaining an environment in which each employee can contribute creative ideas, seek challenges, assume leadership and continue to focus on meeting and exceeding business and personal objectives.