NHS Human Services, Inc.

Claim Specialist of LTC, Legacy Business Solutions - R-118125

DESCRIPTION/RESPONSIBILITIES: Job Classification: Operations - Insurance Operations

Reporting directly to the Director of Long-Term Care (LTC) Operations, this role is responsible for the evaluation of LTC claim reviews and decisions. In addition to managing a caseload, this position offers the opportunity to identify trends to optimize the performance of the organization including providing feedback, initiating continuous improvement, and identifying training opportunities within the claim function.

The current employee work arrangement for this position is dependent on the business preferences and your location, potentially requiring your on-site presence on occasion at a Prudential office.

What you can expect: * Full oversight of assigned caseload of long-term care claim reviews. * Responsible for resolving complex claim issues. * Support legal department with any litigation requests including depositions and serving as a corporate witness. * Identify opportunities to improve customer service and operational claim efficiencies. * Demonstrate excellent organizational and time management skills. * Stay up to date on industry regulations and best practices related to long-term care insurance. * Provides oversight of claim process being performed by Pru LTC Third Party Administrators and deliver feedback to appropriate parties as needed. * Support ongoing strategic claim management initiatives including predictive analytics models.

What you'll need: * Degree in healthcare, nursing, or related field * 10+ years in Long Term Care claims or similar experience including disability claims required. * Ability to manage multiple claim reviews simultaneously, maintain detailed records, and meet deadlines. * Demonstrated strong leadership and management skills, including analytical, organizational and problem-solving skills, which support sound decision making. * Demonstrated superior customer service skills. * Excellent communication skills and interpersonal skills, with the ability to collaborate effectively with both internal and external partners. * Strong analytical skills and critical thinking skills required to review claim documentation, and make informed decisions based on findings. * Ability to work independently to manage difficult interactions. * Proficiency in Microsoft Office.

It'd be a plus if you had: * LHCP certification a plus but not required

What we offer you: * Market competitive base salaries, with a yearly bonus potential at every level * Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave * Retirement plans: 401(k) plan with company match (up to 4%), company-funded pension plan * Wellness Programs to help you achieve your wellbeing goals, including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs * Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development. * Tuition Assistance to help finance traditional college enrollment toward obtaining an approved degree, many accredited certificate programs, and industry designations. * Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.

To find out more about our Total Reward package, see our Total Rewards Brochure. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.

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Note: Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $115,800.00 to $172,300.00. Specific pricing for the role may vary within the above range bas d on many factors including geographic location, candidate experience, and skills. Roles may also be eligible for additional compensation and/or benefits. Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. In addition, employees are eligible for standard benefits package including paid time off, medical, dental and retirement.

Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status , medical condition or any other characteristic protected by law.