Job Description
The HT Group has partnered with an established insurance client in Austin, TX looking for a Remote Long Term Care Claims Eligibility Specialist who is experienced, detail-oriented, and customer-focused to review and manage claims of varying complexity. This is a great opportunity for someone looking to grow within a dynamic and mission-driven environment. This is a fully remote position for candidates outside of the Austin, Texas area. For candidates within Austin metroplex it would be a Hybrid schedule with 3 days in office.
Only candidates with LVN, LPN, LSW certification/license will be considered.
Fully Remote
Direct-Hire
Monday-Friday 8AM-5PM CST
Responsibilities:
- Investigate and evaluate claims for coverage and eligibility
- Analyze relevant documents to support claim decisions
- Establish appropriate Plans of Care based on company guidelines
- Manage short-term and limited approval claims
- Assist with customer complaints and appeals
- Communicate complex claim decisions and coverage details to stakeholders
- Ensure compliance with legal and company claims-handling procedures
- Provide guidance to junior staff and support team leads when needed
Requirements:
- 5+ years of experience in claims management and review, preferably in the insurance industry
- LVN, LPN, LSW certification/license required
- Strong technical knowledge of claims processing and policy evaluation
- Excellent verbal and written communication skills, with empathy and professionalism
- Ability to work independently with minimal supervision
Benefits:
- Competitive Salary & Target Bonus Program
- Retirement Savings – 401(k) with a company match
- Comprehensive Medical insurance through BlueCross BlueShield of Texas. Company-paid dental, vision, short-term & long-term disability, and life insurance.
- Work-Life Balance – 20+ days of PTO, 10 paid holidays, and paid volunteer time off.
- Flexible Work Options – Hybrid /remote opportunities, wellness programs, and weekly paid lunch for onsite staff.
- Health Savings Accounts (HSA) & Flexible Spending Accounts (FSAs) – Includes a company match for HSAs.
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