illumifin

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.

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. - Reviews 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 range starts at $60,000 but can increase depending on experience and qualifications.

Role Description This position performs telephonic interviews for clients who have applied for insurance. Hours of work are Mon-Fri, 9:30a-6:30p 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 - Minimum 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. - Preferred Qualifications - Education: Associate's Degree or Bachelor's Degree in Business Administration. - Database experience preferred. - 1-2 years of prior geriatric and/or mental health nursing and assessment experience. - Work From Home (WFH) Employees must have high speed internet connectivity and an analog or digital phone line. Requirements - The base pay for this position is starting at $16/hour 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. 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. - Responsible for training, quality assurance, and procedural development for Life and Health Claims. - Communicates with internal and external customers regarding actions taken or to be taken. - Performs analysis and oversees projects to enhance department development, client needs, and service objectives. - Provides direction and assistance to the Claims team. - Handles complex claims, including adjustments and complaints, and is a resource to the claims team. - Effectively communicates, in writing and verbally, all aspects of plan coverage, provider requirements, and steps in the claim process. - Responsible for adjudicating more complex claim requests and special handling claims, including reversals, adjustments, and complaints. - Must maintain procedural accuracy of 95% and dollar accuracy of 98%. - Provides training to team (both onshore and offshore), develops training materials, answers questions, checks, and monitors quality of work. - Project management: identifies and develops ongoing needs of the claims department, including evaluating existing system needs and managing required system enhancements and modifications. - Provides input toward solutions to department issues. - Develops new and ongoing procedures and policies for new and existing clients or vendors, including revision of existing policies and procedures. - Improves process flows and efficiencies; work completed and process flows must be prompt, efficient, and accurate. - Oversees and assists with day-to-day activities and inventory while keeping leadership informed. - Provides prompt, courteous, and excellent customer service to internal and external customers at all times. - Demonstrates understanding of company-wide, department-specific policies and protocols. - Maintains the confidential and proprietary nature of company policies. - Other duties and projects as assigned. Qualifications - Minimum of 4 years equivalent business experience. - Knowledge of health, life, or disability insurance, preferred. - Excellent verbal and written communication skills. Requirements - Minimum of 2 years knowledge of Illumifin systems, processes, and designs. - 4-year college degree or equivalent experience. - Leadership experience. Benefits - The base pay for this position is starting at $28/hour depending on experience and qualifications.

Role Description This role sits at the heart of the Long‑Term Care insurance lifecycle. As Manager, Inforce Policy Administration Operations, you will lead a highly experienced team responsible for policy administration, billing, and change management for inforce LTC policies. Your mandate is to stabilize and modernize operations—moving from fragmented, task‑based execution to a results‑driven, data‑led operating model that delivers accuracy, efficiency, and measurable business outcomes. You will have real ownership: financial impact, staffing strategy, service levels, talent development, and continuous improvement. This is a role for a leader who enjoys building disciplined operations, developing people, and partnering closely with leadership, technology teams, and clients. About the Team You will lead a team of approximately 14–19 associates, including Account Analysts and Operations Analysts, supported by senior subject matter experts. The team combines deep institutional knowledge with evolving technology and process improvements. A key focus of this role is to preserve critical expertise through playbooks and succession planning, while helping the organization adopt smarter tools, more predictive planning, and stronger controls. What You’ll Be Responsible For - Operational Leadership & Financial Ownership - Lead the transition from reactive, task-based management to a results-oriented operating model using clear goals, metrics, and OKRs. - Own operational performance and financial outcomes, including service level adherence, quality, and cost control. - Drive aggressive error reduction initiatives through root cause analysis and preventive controls to minimize financial impact (such as interest, penalties, or rework). - Monitor leading indicators to prevent SLA misses and mitigate downstream risk before it affects clients or financial results. - People Leadership, Talent Development & Succession - Lead, coach, and develop a team of professionals, creating an environment of clarity, accountability, and trust. - Establish clear career pathways for Analysts and Leads, supporting development from entry level through senior roles. - Actively manage performance, engagement, and retention; identify and address root causes of attrition. - Build robust succession and knowledge transfer plans, especially for senior SMEs and Lead Analysts, ensuring critical expertise is retained and scalable. - Staffing Strategy, Capacity Planning & Production Control - Use data and forecasting models to move staffing from reactive to proactive, demand-based planning. - Ensure the right work is matched to the right skill level, protecting margin while maintaining quality and speed. - Provide data-driven input into budgeting, staffing adjustments, and long-term workforce planning. - Maintain operational discipline by tracking progress, managing risks, and intervening early when performance trends off target. - Process Improvement & Technology Enablement - Evaluate existing workflows and challenge the status quo through gap analysis and continuous improvement. - Partner with technology and systems teams to identify defects early, track fixes, and ensure smooth deployment through UAT without disrupting production. - Champion the adoption of new tools, automation, and emerging technologies (including AI-enabled capabilities) to improve efficiency and accuracy. - Ensure SOPs remain current, practical, and reflective of best practices. - Client Focus & Stakeholder Partnership - Serve as a trusted operational partner, representing the organization with professionalism and clarity. - Translate complex operational data into clear, actionable insights for clients and internal stakeholders. - Oversee resolution of high priority policy owner complaints and regulatory inquiries, ensuring timely and compliant outcomes. - Cross Functional & Global Collaboration - Partner closely with global counterparts, including teams in India, to ensure consistent standards, quality, and execution across regions. - Work cross-functionally with supporting departments (e.g., Call Center, Mailroom, Technology) to eliminate root causes of errors and improve end-to-end outcomes. - Act as a change leader, guiding teams through process, technology, and operating model evolution. - Risk, Compliance & Audit Readiness - Maintain ongoing readiness for regulatory and client audits. - Represent operations during audits and compliance discussions, including occasional travel. - Ensure operational practices comply with regulatory standards and internal controls. Qualifications - Education: - Associate degree with 10+ years of relevant experience or - Bachelor’s degree (Business preferred) with 7+ years of experience - Experience: - 7+ years in TPA/Healthplan/Insurance Operations (Long Term Care preferred) - 5+ years in a leadership role with accountability for people and performance - Operational & Financial Acumen: - Experience managing SLAs and understanding the financial impact of operational decisions - Tools & Technology: - Intermediate Excel skills (pivot tables, VLOOKUP/data analysis) - Ability to create customer-facing presentations - Experience with front-end use of Power BI, ServiceNow, or Azure DevOps—or willingness to learn quickly - Change Leadership: - Proven ability to lead teams through process, technology, or operating model change Preferred - Experience working with offshore/global teams and distributed domestic teams - Long Term Care or complex in-force policy administration experience Benefits - The annual compensation range starts at $90,000 but can increase depending on experience and qualifications

Role Description This position is responsible for processing all activities in the Policy Owner Services department in a timely manner utilizing extensive knowledge of policy rules, procedures and operations for several clients. Hours of operation are Mon-Fri 7:30-4:30p CST. - Receiving heavy inbound phone calls from policy holders. - Assisting with policy questions such as benefits, filling claims, and rate increases. - Responsible for working the message center, handling unapplied cash, processing policy and billing changes, and refund and returned checks. - Invoicing, reconciling group bills, completing the dunning process, and working all new incoming mail. - Process inflation and Rate Increase offers, Rate Quotes, invoicing, terminations, servicing agent changes, Multi-life group set-up & Collection calls. - Assist in Call Center overflow and process department reports. - Research and respond to escalated requests. - Assist with training new and existing team members. - Communicate daily with various internal departments. - Communicate with external client contacts and participate in client conference calls/meetings. - Contact enrollees to obtain missing information, explain procedures, answer questions, and other inquiries, as needed. - Contact insurance brokers and agents of individual business. - Partner with DST team to ensure procedures are being followed. - Other duties as assigned. Qualifications - College Degree or equivalent work experience, preferred. - Previous Call Center experience. - 1 year experience in the insurance industry, preferred. - Must be able to type at least 40+ words per minute. Requirements - Excellent interpersonal and customer service skills. - Excellent written communication skills are essential. - Excellent time management and organizational skills with the ability to handle multiple tasks while meeting established deadlines and performance standards. Benefits - The base pay for this position is starting at $18/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 range starts at $60,000 but can increase depending on experience and qualifications.

Role Description This position is responsible for the intake, set-up, assigning, follow-up and processing of all on-site assessments for the Assessment Services Division. This area also provides research information on the services provided by agencies across the country for purposes of care coordination and the collection of medical records and documents. Hours of work are Mon-Fri, 10a-7p CST. - Meets, or exceeds, the 85% MOS Productivity Percentage department standard on a consistent basis. - Coordinates the timely completion and processing of on-site assessments by our network of nurses and agencies telephonically. - Provides appropriate assessments to network assessors via fax and/or web upload. - Performs appropriate follow-up to assure the timely return of completed assessments, collection of medical records and/or home health care research information. - Documents any action or communications accurately that occur regarding on-site assessments or requests and escalates all delays and customer concerns to the appropriate management level. - Communicates accurate, timely and appropriate information to keep the customer informed of the status on all assessment requests. - Collects missing and/or ineligible information to ensure timely and accurate processing of all completed on-site assessments or information requests. - Interacts and communicates with On-site Assessors, Health Care Agencies, Health Care Facilities, Care Coordinator Supervisors and Claims Assistant Directors to assure customer expectations are met or exceeded. - Researches agencies regarding home care services available including pricing. - Negotiates provider rates for the most cost-effective services for the customer. - Completes provider research forms with all needed information in an accurate, detailed and timely manner. - Maintains confidentiality and compassion in handling all customer information. - Upholds 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. - Other duties as assigned. Qualifications - High school diploma or equivalent G.E.D. - One year of telephonic customer service experience in an office and/or business environment. - Type at least 40 words per minute. - Proficient in basic computer software including Microsoft Office. - Detail oriented with excellent organizational, listening and communication skills. - Positive interpersonal skills. - Ability to perform basic functional math skills. - Ability to manage to a deadline. Requirements - 2+ years of telephonic customer service experience in an office and/or business environment (preferred). - Prior experience in the geriatric health care or insurance industry (preferred). Benefits The base pay for this position starts at $16/hour depending on experience and qualifications.

Role Description The Senior Underwriter will examine, review, evaluate, classify and rate customer documents in order to determine compliance with company guidelines, underwriting criteria, philosophy, policy and procedures. Ensures timeliness, accuracy and productivity levels established by management. - Provides leadership to lower level underwriters in their file review and underwriting in accordance with established protocols and underwriting criteria. - Working under minimal supervision with a great deal of autonomy, review application and supporting documentation to ensure accuracy and completeness. - Using established protocols, underwriting guidelines and procedures, analyzes risk, ensuring decisions are consistent with client and corporate guidelines and programs. - Approves, declines or rates the application within the established criteria, while utilizing clinical judgment. - Demonstrates knowledge to underwrite multiple clients accurately within the protocols specified for each client. - Quickly but carefully read, analyze and interpret medication lists, medical records, phone and in-person assessments, cognitive test scores, MIB and Prescription profile results (where applicable) and properly document findings. - Assess risk of Long-Term Care using lifestyle, medical and cognitive information while processing a minimum of 50 cases weekly. - Demonstrates effective communication and customer service skills both internally and externally, that includes use of the notepad and log, appropriate wording of decline letters, professional verbal communication with coworkers, applicants and clients. - Prepares responses to special needs letters to applicants and clients. - Assists with the daily processing for lower level underwriting staff, including mentoring, team conference and individual instruction utilizing the protocols and procedures established. Qualifications - BA, BS, RN or equivalent insurance industry experience - Minimum of 3 years LTC/Life underwriting experience including working with agents - Strong command of Medical Terminology - Proficient PC skills - Typing speed of 50 WPM or better - Time management skills - Good analytical abilities - 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 - Experience with MIB and Prescription databases Benefits - The annual compensation range starts at $70,000 but can increase depending on experience and qualifications