Claims Manager - LSW or RN

About the Role

illumifin is seeking a Claims Manager to handle long-term care insurance claims for home- and facility-based care, including standalone and hybrid policies, as well as chronic illness riders and/or critical illness claims. This role sits within a company that supports a workplace culture centered on respect, integrity, continuous learning, and initiative.

The organization is a major business process outsourcing partner for the insurance sector, administering more than 1.3 million long-term care policies for some of the country’s largest insurers. Its work is supported by proprietary long-term care data that helps deliver risk-management insight to clients.

What You’ll Do

• Assess routine claims using internal systems, client instructions, and policy wording to reach eligibility decisions in line with departmental standards and procedures.
• Keep in regular contact with claimants, authorized representatives, third parties, physicians, and care providers through letters and phone calls, meeting service-level expectations and coordinating with teammates and leaders when needed.
• Contact service providers to confirm licensure, obtain proof of loss, and verify dates of service, while checking that the care provided fits the diagnosis, contract terms, and applicable healthcare regulations.
• Record all claim activity accurately and clearly in the required systems and databases.
• Develop care plans and complete chronic illness certification when appropriate.
• Deliver courteous, timely, and high-quality service to both internal teams and external customers.
• Communicate effectively, use sound judgment about information sharing, and follow HIPAA and legal release requirements when distributing case details.
• Work with accuracy, manage priorities effectively, and keep workload organized.
• Contribute in team meetings and support coworkers when additional help is needed.
• Follow compliance standards as defined by the Code of Conduct, Employee Handbook, and related policies, and take part in mandatory corporate compliance training as required.
• Consistently meet the department’s quality and productivity targets.
• Operate independently with minimal supervision.
• Take on additional responsibilities as assigned.

Requirements

• LSW or RN credential is required for this Claims Manager position.
• Ability to interpret policy language, client guidelines, and internal procedures in order to make eligibility determinations.
• Strong written and verbal communication skills for interacting with claimants, providers, and internal stakeholders.
• Attention to detail and the ability to maintain thorough, accurate documentation.
• Capacity to prioritize work, manage multiple cases, and meet production and quality expectations.
• Understanding of HIPAA, confidentiality, and healthcare information release practices.
• Comfort working independently while also collaborating with a team when necessary.
• Knowledge of provider verification, licensure review, and care appropriateness assessment.

Additional Information

This role involves evaluating eligibility decisions for long-term care claims and reviewing/chronic illness certification within the limits of client contracts and policy terms. The position is based in Minnesota, United States and is an onsite full-time opportunity.