Job Description

Job Description
The Claims Coordinator - LTC is responsible for supporting consistent delivery of timely and accurate claims management and quality customer service for all LTC claims and members. Effectively collaborates with Claims Analysts, Claim Managers, RN Case Managers, Care Claims Consultant, and Director, along with care providers, LTC and LCP members, and their representatives.
Assigned duties include:
- Review and distribute incoming documents received in the LTC Claim Box and LTC Fax Box;
- Complete registration of Benefit Request Forms (new claims);
- Research and respond to HMS (Medicaid) inquiries;
- Process Return of Contributions;
- Research and effectively respond to requests for Benefits Summaries and Explanation of Benefits (EOB) Forms;
- Complete death claim processing and related follow-ups;
- Review and update diverse follow-up activities and claims documentation;
- Process requests to initiate Electronic Fund Transfer and Assignment of Benefits;
- Assist with claim overpayment processing and related follow-up activities;
- During peak times, assist with LCP functions including call center and scanning;
- Generate benefit exhaust correspondence and related claim documentation
- Provide accurate and timely communications within prescribed policies, procedures, regulations, and service metrics.
- Collaborate effectively with fellow LTC/LCP team members, along with internal and external partners.
- Analyzes and enters information from multiple sources and utilizes multiple computer systems, programs, and databases.

Required Qualifications
1 or more years of administrative and/or customer service

Preferred Qualifications
2 or more years LTC, disability, and/or customer service experience preferred.
Strong analytical and critical thinking skills required; Demonstrated ability to effectively prioritize and execute diverse tasks with high degree of accuracy and timeliness; Organized and conscientious with strong follow-through; Proven proactive, positive, collaborative team player and problem solver;
Demonstrated success working in a multi-system (i.e., both mainframe and Windows) environment;
Proven success communicating verbally and in writing with both external customers and internal business partners;
Experience gathering and explaining complex information; Strong financial and general business acumen;
Ability to effectively work independently and as and engaged member of a collaborative team;
Demonstrated commitment to continuously improving operational efficiency and effectiveness
Demonstrated regular and predictable attendance; Willingness to take on additional tasks as assigned by Director.

Education
High school diploma/GED required. Bachelors degree preferred.

Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.