Senior Account Manager
New
J
JobgetherInsurance
Based in United StatesFull-TimeSenior
SalaryCompetitive base salary range of $125,000 to $140,000 for eligible locations, plus annual bonus opportunities.
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Job Details
- Experience
- 8+ years of progressive experience in Long-Term Care claim adjudication
- Required Skills
- Client relationship managementProcess improvement
Requirements
- Bachelor’s degree in a relevant field.
- 8+ years of progressive experience in Long-Term Care claim adjudication.
- Demonstrated experience managing client-facing claim responsibilities, including consultation, issue resolution, relationship management, and presenting recommendations.
- Experience leading or participating in external claim audits and preparing detailed audit reports.
- Experience identifying training opportunities, developing educational materials, and supporting claim process improvements.
- Strong knowledge of direct insurance company claims operations and LTC claim management practices.
- Ability to analyze claim trends, prepare business reports, and translate findings into practical recommendations.
- Excellent written and verbal communication skills with the ability to engage technical and non-technical audiences.
- Strong problem-solving abilities with the creativity and judgment needed to improve processes and resolve complex challenges.
- Ability to work independently, manage priorities effectively, and collaborate with internal and external stakeholders.
Responsibilities
- Serve as a senior advisor on Long-Term Care claims, providing expertise in claim adjudication, medical impairment assessment, and industry best practices.
- Manage and review complex, high-liability, high-dollar, and contestable claims requiring advanced clinical, contractual, legal, or administrative analysis.
- Evaluate claim management practices against applicable guidelines, policy provisions, contractual requirements, and industry standards.
- Assess potential risks, fraud indicators, liability concerns, and emerging issues while providing actionable recommendations to leadership.
- Lead and participate in external claim audits, including planning, file reviews, report preparation, findings discussions, and recommendation follow-up.
- Develop and deliver client training programs, educational materials, claim tools, and resources to improve operational consistency.
- Build and maintain strong client relationships by addressing claim-related questions, resolving issues, and supporting account management activities.
- Analyze claim trends, operational performance, and adjudication patterns to create business reports and improvement recommendations.
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