illumifin

Role Description The Customer Service Representative - Assessment Services role works with insurance companies, their applicants, claimants, agents, underwriters, and claims departments in an effort to complete both telephonic and face-to-face assessments. This position also works with the National Network of Nurses to coordinate the assignment, follow-up, and completion of face-to-face assessments. We are seeking a schedule of Mon-Fri, 9a-5:30p CST. - Compassionately fields incoming calls from insurance company home office personnel, underwriters, agents, insurance policy applicants, claimants, and case managers to: - Provide telephonic and onsite interview status information - Schedule appointments for telephonic interviews - Collect and disseminate new or updated applicant or claimant information - Coordinate requests for reprints of telephonic and onsite interviews - Hot transfer applicants to complete telephonic interviews - Handle incoming calls from independent contracted nurses and agencies to assign, update status, and collect missing information on underwriting and claims onsite assessments - Understand and work comfortably with all duties, processes, and policies in the Engagement Services Call Center and Assessment Services departments - Demonstrate a high level of confidentiality and integrity when handling customer questions and personal information including, but not limited to: - Financial, personal, medical, and/or health-history information - Utilize multiple illumifin specific database platforms to input, access, and follow-up on customer information and activity - Provide ongoing, compassionate, and proactive customer support to all Engagement Services customers Qualifications - Must be able to speak French (Canadian Dialect) - High school diploma or GED required - Strong written and verbal communication skills; familiar with business and phone protocols - Excellent organization and detail orientation skills with the ability to meet established deadlines - Proficient with MS Windows environment, including MS Word - Reliable, trustworthy, and maintains appropriate organizational confidentiality - Minimum of one year customer service experience working in a fast-paced, ever-changing call center environment Requirements - The base pay for this position is starting at $17/hour depending on experience and qualifications Company Description illumifin is a leading provider of business process outsourcing for the insurance industry, managing over 1.3 million long-term care policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary long-term care databases.

Role Description The Licensing Specialist is responsible for completing the agent appointment and on-boarding process in a fast-paced, multi-tenant environment. Successful Processors in this role are dependable, proactive, and will maintain Productivity, Efficiency, and Quality performance standards, within Service Level Agreements. - Agent onboarding, including but not limited to reviewing agent-contracting paperwork for completeness and accuracy, and documenting incorrect and/or missing items. - Enter acceptable agent contracts into the system of record. - Review and respond to emails from agents and/or their staff regarding their appointment/onboarding information, clearly communicating the requested information and next steps where applicable. - Additional responsibilities as assigned by Manager. Qualifications - Solid partnering skills which contribute to building relationships with partners and other service team members; displays outstanding communication and interpersonal skills (oral and written). - Self-directed ability to multi-task and prioritize appropriately when competing demands and large volumes develop, both as part of a team and individually; ability to adapt and work effectively in a continuously changing environment. - Solution-oriented individual demonstrating solid analytical and problem-solving skills. - Ability to seek out developmental opportunities and continuously improve skills. - Consistently demonstrate a high level of professionalism through a strong work ethic that positively influences the work habits of the team. - Detail oriented with a focus on quality and consistently meeting goals. Requirements - The base pay for this position is starting at $21/hr. depending on experience and qualifications. Company Description illumifin is a leading provider of business process outsourcing for the insurance industry, managing policies for the nation's largest insurers. We also provide clients with unique risk management insight built upon our proprietary databases.

Role Description This position is responsible for reviewing and determining all claim requirements needed for initial and continuation claims. This position assists Care Managers and Care Coordinators, while also providing quality customer service to our policy holders, their representatives and providers. - Reviews internal databases, client guidelines, and policy contract language to determine all claim requirements needed for initial and continuation claims. - Reviews documented claim forms and contacts the insured, insured's representative, or provider to request information needed to process the benefit inquiry. - Keeps clear and concise documentation of all claim intake activity within the required databases. - Meets quality and production metrics as established and communicated by the department. - Processes requests from the client or from other departmental areas within illumifin. - Other duties as assigned. Qualifications - Associates Degree or equivalent formal training program, or 2 years experience in the health or life insurance industry. - 1-3 years work experience in a claims environment preferred. - Intermediate level experience with Microsoft Office products. Requirements - Experience working in a geriatric healthcare environment. - Knowledge of health, long-term care or disability insurance. - Excellent verbal and written communication skills. Benefits - The base pay for this position is starting at $18.50/hour depending on experience and qualifications.

Role Description This position performs telephonic interviews for clients who have applied for insurance. We are looking at a working schedule of Mon-Fri, 8a-5p or 9a-6p CST. - Conducts telephonic interviews for insurance company applicants in a quiet, professional environment without interruptions and/or distractions. - Receives calls from CSR area to complete telephone interviews with Long Term Care applicants. - Uses pre-determined follow-up questions needed for a thorough collection of data. - Gives concise, accurate documentation on client's health history. - Accurately documents history and lifestyle information essential to the Underwriting process using pre-determined, scripted follow-up questions. - When necessary, tactfully refocuses applicants who wander off the subject. - Completes all interviews in a timely manner, according to department guidelines. - Maintains an 85% productivity level as measured by the Management Operating System in place (MOS). - Maintains a minimum 96% quality standard on all telephonic interviews. - Other duties that are assigned. Qualifications - Education: high school diploma - Proficient in basic computer software with the ability to troubleshoot basic computer issues, including Microsoft Office Suite. - Must type at least 40 words per minute. - Basic functional math skills. - Performs work accurately and efficiently under deadline pressures. - Heavy telephone contact with both customers and internal company staff. - Heavy keyboard and computer use. Requirements - Education: Associate's Degree or Bachelor's Degree in Business Administration (preferred). - Database experience preferred. - 1-2 years of prior geriatric and/or mental health nursing and assessment experience (preferred). - Work From Home (WFH) Employees must have high speed internet connectivity and an analog or digital phone line. Benefits - The base pay for this position is starting at $16/hour depending on experience and qualifications.

Role Description The Claims Manager position is responsible for evaluation and rendering eligibility decisions on home and facility-based Long Term Care claims (standalone and hybrid), chronic illness riders and/or critical illness within client contract and policy parameters, while providing quality customer service to our policy holders, their representatives and providers. - Review internal databases, client guidelines and policy contract language to evaluate routine home and facility-based claims, in accordance with department processes and standards. - Communicate clearly and routinely with claimants, representatives, third parties, physicians and healthcare providers via written letters and phone calls as required by agreed upon SLAs. - Effectively communicate with team members and leadership on cases, as needed. - Query service providers to obtain licensure information, proof of loss and dates of service. - Verify that provider and/or care is appropriate based on the claimant’s diagnosis and is in accordance with contract language and government regulations regarding healthcare providers. - Maintain clear and concise documentation of all claim activity within the required databases. - Create plans of care and complete Chronic Illness Certification as appropriate. - Provide prompt, courteous and excellent customer service to internal and external customers. - Demonstrate effective communication skills, level of attentiveness and use of appropriate lines of authority. - Promptly share accurate and complete information to others who need it, based on HIPAA and legal documents regarding release. - Perform work accurately and demonstrate ability to prioritize workload. - Participate in team meetings and assist colleagues with their workloads when appropriate. - Uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. - Support and participate in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required. - Meet established quality and production expectations as established and communicated by the department. - Work independently with minimal direction. - Other duties as assigned. Qualifications - Current and Unrestricted Registered Nurse (RN) or Social Work license. - Four-year college degree or equivalent formal training program. - Two years’ experience in medical, insurance or risk management setting. - One-year work experience in claim processing. - Intermediate level experience with Microsoft Office products. - Excellent verbal and written communication. Requirements - Experience working in a geriatric healthcare environment (preferred). - Knowledge of health, long-term care of disability insurance (preferred). Benefits - The annual compensation target is at $60,000 depending on experience and qualifications.

Role Description This position supports the daily operations of the Underwriting Department by reviewing underwriting requirements and determining underwriting decisions of applicant files. The Underwriter will communicate with agents and clients on decisions. This role is expected to last approximately 6 months. - Quickly but carefully read, analyze and interpret medication lists, medical records, phone and in-person assessments, cognitive test scores and properly document findings - Assess risk for Long Term Care using lifestyle, medical and cognitive information while processing a minimum of 50 cases weekly - Using established protocols, underwriting guidelines and procedures, analyzes risk, ensuring decisions are consistent with client and corporate guidelines and programs - Perform work accurately and efficiently under deadline pressures - Maintains a minimum of 98% accuracy in underwriting decisions - Conducts phone history interviews, as warranted - Handle calls from agents regarding underwriting decisions - Prepare correspondence to applicants, doctors, agents, etc. - Other duties and projects as assigned Qualifications - BA, BS, RN or equivalent insurance industry experience - 1+ years LTC, Life or DI underwriting experience - Working knowledge of Medical Terminology - Proficient PC skills - Typing speed of 50 WPM or better - Time management skills - Ability to work independently as well as in a team - Strong communication skills Requirements - Long Term Care Professional designation or other Long Term Care Insurance related designation (preferred) - FLMI, ALU or CLU highly desirable (preferred) Benefits The base pay for this position is starting at $25/hr. depending on experience and qualifications.

Role Description This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility. - Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination. - In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider. - Effectively communicate, verbal and written, all aspects of the claim benefit determination process. - Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider. - Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately. - Attend case conferences, internally and with the client, to present claims recommendations. - Meet quality and production metrics as established and communicated by the department. - Other duties as assigned. Qualifications - Associates Degree or equivalent formal training program, or 2 years experience in a medical or insurance environment. - At least 3 years work experience with claims and insurance contract interpretation. - Intermediate level experience with Microsoft Office products. Requirements - Experience working with healthcare, long-term disability or long term care claims. - Familiarity with nursing home and home care service providers and service delivery settings. - Excellent verbal and written communication skills. Benefits - The pay target for this role is at $24/hour depending on experience and qualifications.

Role Description The Program Manager leads strategic programs that enable clients and our organization to confidently achieve meaningful outcomes – on time, within budget, and with high quality. By fostering alignment across stakeholders and ensuring governance, Program Managers help transform ideas into results that improve client experience and operational excellence. This role ensures strong governance, stakeholder alignment, and effective communication throughout program planning and execution. This work ensures clarity, accountability, and progress for the initiatives that matter most, while creating an environment where teams can thrive and deliver with purpose. Responsibilities - Monitor program performance, risks, and issues; implement corrective actions as needed. - Govern program execution and ensure adherence to organizational standards and methodologies. - Partner with Account Managers to understand client objectives and communicate program status. - Develop strategic program roadmaps by guiding cross-functional teams to define objectives, projects, business cases, milestones, and sequencing. - Oversee intake-to-approval process for program-level initiatives, including scoping and estimation. - Monitor program progress, risks, issues, and dependencies; escalate and resolve barriers. - Provide accurate reporting and insights to leadership and clients on program health and outcomes. - Drive accountability across delivery teams to meet timelines, budgets, and quality standards. - Facilitate stakeholder communication and alignment throughout planning and execution. - Collect and analyze data to prepare and present clear, compelling insights for key stakeholders. - Contribute to continuous improvement by identifying process gaps and recommending enhancements. - Mentor or coach to junior project management resources. Qualifications - Bachelor’s degree in business, technology, or related field. - 5+ years of experience managing complex programs with multiple projects and stakeholders. - Proven record of delivering programs or initiatives on time and within budget. - Ability to orchestrate, organize and drive outcomes utilizing a collaborative style. - Experience implementing change management to support organizational transitions and adoption of new processes or systems. - PMP, Agile or equivalent certification. - Strong written and verbal communication skills, e.g., ability to write detailed, understandable notes and other business documents. - Strong facilitation, negotiation, and stakeholder management skills. - Ability to manage multiple responsibilities under deadline pressure. - Proficiency in Microsoft Office Suite, including Word, Excel, PowerPoint, and Visio. - Proficiency in Microsoft Project and project consolidation and management tools (“PPM”). Preferred Qualifications - Master’s degree - Experience within the insurance industry, preferably in life, health, annuity, or long-term care lines of business Salary The salary range for this position is $115,000-$160,000 depending on experience and qualifications.

Role Description The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning and initiative. This position is responsible for gathering and reviewing requirements for the purpose of determining initial and ongoing claimant and provider eligibility. - Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination. - In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider. - Effectively communicate, verbal and written, all aspects of the claim benefit determination process. - Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider. - Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately. - Attend case conferences, internally and with the client, to present claims recommendations. - Meet quality and production metrics as established and communicated by the department. - Review Care Coordinator decision recommendations on tax qualified policies. - Other duties as assigned. Qualifications - RN Nursing or Social Work license. - 3 years work experience with older adult population. - Intermediate level experience with Microsoft Office products. - Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required. Requirements - Care planning experience preferred. - Experience with insurance contract interpretation preferred. - Excellent verbal and written communication skills. Benefits - The annual compensation target is at $60,000 depending on experience and qualifications.

Role Description The nation's leading administrator of insurance services is looking for YOU. This is your opportunity to join a company with a culture that promotes respect for people, integrity, learning, and initiative. WE ARE THE KIND OF EMPLOYER YOU DESERVE. Account Management professionals are responsible for providing organized, efficient, and profitable implementation of new business or process improvements for existing business. This role will include: - Acts as the primary point of contact and proactively manages assigned clients to promote positive long-term client relationships. - Executes the implementation of new clients. - Manages daily, weekly and/or monthly reports required by clients including the coordination, development, and facilitation of reports. - Works with internal departments to develop and maintain business requirements for new or existing clients. - Coordinates and prepares pricing and contract updates as well as the development and management of projects or department timelines as needed. - Works with client(s) in budget development, strategic and tactical planning, and goal setting. - Communicates effectively with senior leaders and staff, presenting information in a succinct and understandable format. - Works closely with internal departments to ensure communication and execution of all account and business initiatives. - Prepares documents for establishing Service agreements with clients and potential clients, investigating and resolving issues within respective accounts. - Identifies opportunities to expand the business with existing clients through introducing new products and services. - Handles client inquiries, resolves issues, and ensures a timely response to concerns. - Monitors key account metrics, analyzes client data, and identifies areas for improvement. - Oversees the delivery of project estimates to clients ensuring timely delivery and follow-up. - Provides input and support on client budget targets to meet company goals. - Other duties as assigned. - New account and business implementation including: - Communicates with clients and internal departments to facilitate a smooth implementation. - Works closely with internal departments to ensure communication and execution of all account and business initiatives. - Account management including: - Directs and proactively manages an assigned client base to promote positive, long-term client relationships. - Supports and executes the installation of new clients. - Conducts regular meetings to communicate business updates with both internal and external customers. - Responsible for the coordination, development, and facilitation of daily, weekly and/or monthly reports required by clients. - Works directly with new or existing clients to develop and maintain business requirements. - Manages project and department timelines. - Creates and delivers presentations to current and potential clients. - Stays informed on all aspects of the operation related to assigned client(s). - Maintains strong relationships with the operations managers and departments including senior management. - Acts as client advocate as well as supporter of what is in the best interest of the enterprise. Qualifications - Minimum of BA/BS degree or equivalent work experience plus 3+ years long-term care industry or operational experience. - LTC or Health Plan experience preferred. - Ability to manage projects to a deadline. - Detail-oriented with excellent organizational skills. - Proven ability to develop strong relationships and play a leadership role. - Ability to recommend and make process improvements when needed. - Must be self-motivated and exhibit a history of meeting or exceeding goals. - Ability to listen to client needs and enterprise requirements to develop, manage, and execute a mutually beneficial solution. - Awareness of how to present the enterprise in a polished and professional manner in written, verbal, and presentation settings. - Ability to travel. - Proficient in Microsoft applications. Requirements - The base salary target for this position is at $70,000 depending on experience and qualifications.