What are the responsibilities and job description for the Lead, Care Manager position at illumifin?
illumifin is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary long term care databases.
- Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination.
- In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider.
- Effectively communicate, verbal and written, all aspects of the claim benefit determination process.
- Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider.
- Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately.
- Attend case conferences, internally and with the client, to present claims recommendations.
- Meet quality and production metrics as established and communicated by the department.
- Reviews Care Coordinator decision recommendations on tax qualified policies.
- Handle escalated claims that are of sufficient severity or complexity. Identify and develop ongoing needs of the department, providing input toward solutions of departmental issues. Provide ongoing training and procedural and clinical direction of Care Management staff, as well as claims department staff, as needed.
- Coordinate the Practice Standards and Quality Assurance programs for the department.
- Oversee projects to enhance departmental development, client needs, and service objectives.
- Provide management oversight and direction in the absence of the team supervisor.
- Manages work load and time frames
- Reports to management with workload observations
- Provides reports and data analysis as needed
- Provides limited direction to teams
