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Excellus BCBS · 3 days ago

Long Term Care Benefits Planner I/II (Rochester Region)

Rochester, NY

Full-time

Onsite

Entry, Mid Level

$60K/yr - $107K/yr

3+ years exp

Excellus BCBS is seeking a Long Term Care Benefits Planner I/II to evaluate and manage insureds accessing their long-term care benefits. The role involves assessing eligibility, coordinating care, and ensuring compliance with insurance contracts while maintaining member privacy and integrity.

Health CareHealth InsuranceNon Profit

Work & Life Balance

Responsibilities

Operates as a case advisor for Insureds accessing benefits under their LTC policy as key contact and advocate for Insured and their family. Independently manages a caseload of Insureds in accordance with time-service standards required by the Company

Evaluates Insured’s condition through review of field assessments, medical records, etc. Determines benefit eligibility based on the criteria outlined in the LTC policy (contract)

Develops and assists with appropriate plan of care for Insured. Provides referrals to external vendors to assist in putting care in place and managing private caregivers

Defines the services covered and not covered under the terms of the contract and assists with the arrangement of services as is deemed necessary

Evaluates submitted claims to determine if services billed and provided are consistent with the approved plan of care. Develops and documents alternate plans of care as deemed appropriate under the terms of the insurance contract

Reviews the Insured’s benefit file and claim payment to encourage timely submission and adjudication of claims within company and State time service standards

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

Regular and reliable attendance is expected and required

Performs other functions as assigned by management

Manages a larger and/or more complex caseload of Insureds while maintaining time-service requirements

Trains and mentors less experienced LTC Benefit Planners including interpretation of more difficult policy language. Provides guidance and leadership regarding the daily activities of department. Acts a resource to staff, management and vendors

Identifies and develops processes and guidelines for performance improvement opportunities for the Department

Expert and resource for escalations - Serves as subject matter expert and if called upon, works directly with the operation to resolve issues and escalated problems

Qualification

NYS RN LicenseLong term care experienceBachelor's degree in social workCase management experienceAnalytical skillsMicrosoft Office proficiencyCommunication skillsAttention to detailProblem-solving skills

Required

Three (3) years combined experience in insurance and/or a clinical setting

Active NYS RN License or bachelor's degree in social work or related field. In lieu of an RN or bachelor's degree, an associate's degree or LPN with a minimum of two (2) years' experience in long term care claims adjudication and two (2) years long term care customer service

Must have the ability to review and interpret medical records and assessments for the purpose of determining eligibility for benefits

Basic analytical and problem-solving skills

Ability to speak on confidential medical issues with customers

Must display a high degree of professionalism and have strong written and verbal communication skills

Attention to detail

A working knowledge of Microsoft Office applications is required. Skillful at working between multiple programs and applications at the same time

Four (4) years combined experience in insurance and/or clinical setting, or the candidate must have a minimum of two years combined experience in the Level I position

Active NYS RN License or LMSW; or LCSW

Ability to deliver efficient, effective, and seamless care to members

Demonstrates ability to escalate to management, as necessary

Demonstrates proficiency in all related technology and documentation requirements

Preferred

Experience in long term care setting or with geriatric populations is preferred

Prior case management experience preferred

Benefits

Participation in group health and/or dental insurance

Retirement plan

Wellness program

Paid time away from work

Paid holidays

Company

Excellus BCBS

Glassdoor4.0

Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to about 1.5 million people across upstate New York.

Founded in 1932

Rochester, New York, USA

5001-10000 employees