Claims Intake Specialist
Transamerica Life Insurance (Fort Worth, Texas)

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Located in Bedford, TX (DFW Metroplex), we administer products that are designed to meet the long-term health care needs of our customers during their retirement years. Our products provide insurance coverage for confinements in a nursing home or assisted living facility, or for professional and non-professional care received in the home or community usually due to a prolonged illness or disability. Our 280 employees are committed to enhancing our financial results through growth, creativity, innovation, risk management, and service while treating our policyholders, employees and other business relationships with integrity and respect. 

We offer a comprehensive benefits package, and a welcoming and friendly working environment that includes free parking, year-round business casual attire with casual dress Fridays and health club reimbursement. Our employees actively serve on a variety of company-sponsored committees such as health and safety, charity and employee appreciation. Many employees are active in contributing to the community through efforts such as the Alzheimer's Association Memory Walk, Food Drives, United Way, Blood Drives, CPR Classes and Toastmasters.

GENERAL SUMMARY:

The Intake Specialist determines benefit eligibility for policy holders receiving Long Term Care such as in a Nursing Home, Assisted Living Facility, Hospice, and/or Home Health Care.  In addition, the Intake Specialist coordinates with external vendors in ordering assessments, evaluations, and plans of care. Communicating in writing or via phone with clients, family members, agents, physicians and discharge planners on eligibility requirements, policy benefit eligibility determinations, state facility licensing requirements, and contract provisions is a daily responsibility. 

PRINCIPAL DUTIES AND RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO:

Review and interpret medical necessity, non tax qualified and tax qualified long term care policies

Answer, service and document all notice of claim calls pertaining to policy benefits

Determine provider eligibility                                                                               

Determine policy holder’s initial and on going eligibility                          

Interface with external contracted vendors                                                

Process documentation in the electronic data system                                        

Provide daily/weekly/monthly statistics regarding productivity                             

JOB SPECIFICATIONS:

1.      Knowledge, skills and abilities normally required for competent performance in this job:

¨      Ability to communicate clearly and effectively verbally and in writing

¨      Ability to handle customers in a calm, professional, friendly & patient manner 

¨      Excellent organizational and time management skills

¨      Attention to detail

¨      Ability to type accurately

¨      Ability to work within a Windows Operating system and related programs

¨      Moderate proficiency working with Microsoft XP, Microsoft Excel, and Microsoft Word

¨      In-depth Knowledge of all aspects of the various company policy products

¨      Ability to communicate policy information in a clear and detailed manner

¨      Ability to be a team player

2.  Typical background and experience required or preferred for competent performance in this job.

¨      Requires a minimum of an Associates degree, Bachelors or Masters degree is preferred.

¨      Requires licensure as a Nurse (LVN, RN), Physical Therapist (PT), Occupational Therapist (OT), Licensed Bachelor of Social Work (LBSW), Licensed Professional Counselor, or Certified Case Manager (CCM) 

¨      1 – 3 years experience working in a long term care insurance industry or long term care medical setting or 5 – 7 years experience working in the health care insurance industry such as, case management, care coordination, under writing, or claims examining is required

¨      May substitute degree and/or licensure for 7-10 years in risk management or strong background in health insurance industry such as examination or underwriting (major medical or disability income)