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

Wisconsin, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

Insurance, Long-Term CareIndustries

Requirements

Candidates should possess a Registered Nurse or Social Work license, or have a healthcare background or a minimum of 3 years of long-term care insurance experience. A bachelor's degree or equivalent combination of education and work experience is required, along with desirable experience in insurance claims. Strong written and verbal communication, technology skills, analytical skills, personal organization, time management, client focus, customer service skills, and the ability to manage ambiguity and identify process improvements are essential. The ability to analyze medical records and draw out necessary information for claims processing is also a requirement. Candidates must be able to work core business hours of 8:30 AM to 5:00 PM CST.

Responsibilities

The LTC Claims Pending Specialist will determine the applicability of benefits by interpreting contract provisions and state regulations, and use claim knowledge to analyze facts and make decisions on new and continuing claims. This role involves ordering and reviewing medical, investigative, and service provider information to determine claim eligibility and reimbursement. Responsibilities include conducting interviews to gather claim information, explaining claims status and contract provisions to insureds and their representatives, and communicating effectively with various parties. The specialist will also be responsible for preserving the company's image during benefit approval or denial processes and may participate in project and committee work as a Subject Matter Expert. Collaboration with team members to achieve departmental goals is also expected.

Skills

Long-term care insurance

Claims processing

Contract interpretation

State regulations

Medical record review

Interviewing

Communication

Negotiation

Conflict resolution

Registered Nurse

Social Work

Northwestern Mutual

Provides financial security services, and wealth management

About Northwestern Mutual

Northwestern Mutual offers personalized financial planning, life insurance, and investment services, leveraging leading-edge technology to manage over $125 billion in client assets for more than 4.5 million clients.

Milwaukee, WisconsinHeadquarters

1856Year Founded

N/ACompany Stage

Consulting, Fintech, Financial ServicesIndustries

10,001+Employees

Benefits

Growing your Career

Compensation & Time Off

Insurance plans

Health Savings Account

Wellness programs & resources

401(k) plan and cash balance contributions

Risks

Fintech platforms like Carefull challenge traditional financial advisory services.

Internal competition may arise from Wellthi's focus on the Black community.

Customer dissatisfaction may grow due to increased retirement age expectations.

Differentiation

Northwestern Mutual maintains the highest financial strength ratings in the industry.

The company launched 'The Great Realization' campaign to refocus customer priorities.

Northwestern Mutual offers a unique Long-Term Advantage product with life insurance benefits.

Upsides

The aging population increases demand for retirement planning and long-term care solutions.

Partnerships with tech firms enhance Northwestern Mutual's data analytics capabilities.

Digital transformation in insurance leads to more personalized customer experiences.

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