Care Coordinator - LTC Claims

About the company

illumifin is a business process outsourcing partner serving the insurance sector. The company administers more than 1.3 million long-term care policies for major insurers and uses its proprietary long-term care data to provide risk management insights.

The organization emphasizes a workplace culture built on respect, integrity, learning, and initiative.

Role overview

This role focuses on collecting and evaluating information to decide whether claimants and care providers meet the criteria for initial and continuing eligibility under long-term care claim guidelines.

Key responsibilities

• Review medical documentation from active providers and speak with claimants or their legal representatives to assess whether the claimant meets eligibility standards; if details conflict, arrange a benefit eligibility review before finalizing the decision.
• Use the plan terms, licensing records, state rules, online research, and phone conversations with providers to confirm that care providers are valid and eligible during both the first review and ongoing recertification.
• Communicate claim benefit decisions clearly and professionally in both spoken and written formats.
• Support claimants when their care plans need updates, including changes in care requirements or provider replacement.
• Track daily, weekly, and monthly reporting to make sure claims are processed accurately and within required timelines.
• Participate in internal and client case conferences to present claim recommendations.
• Work toward the quality and productivity goals set by the department.
• Take on additional tasks as needed.

Additional information

The employer describes itself as a leading administrator of long-term care insurance services and invites candidates to join a team that values people, integrity, learning, and initiative.