LTC Claims Eligibility Specialist, Licensed (Remote)

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. #HPIND Apply tot his job