Case Manager - Claims

Reference Number: 16140009
Location: Framingham, Massachusetts, US
Category: Medical / Health

The Case Manager 1 handles a variety of Long Term Care (LTC) Claims in a fast paced office setting including: utilizing claim policies and guidelines, reviewing policy coverage and qualifying providers, determining claimant eligibility, communicating with and educating policyholders and providers on benefits, and negotiating alternative care benefits as applicable. The Case Manager 1 directly manages a daily caseload of claims and may be required to present claim facts during department claim discussions.


My client is an emerging provider of full-service insurance management solutions with a focus on the Long Term Care market. Headquartered in Framingham, MA, and with operations at locations throughout the United States, they provide comprehensive administration support and targeted services in: Policyholder Administration, Claim Management/Payment and Actuarial Services including Rate Increase Support.


  • Claims Manager (not management of people, managing process)
  • Bachelor’s degree or equivalent experience
  • Typically a minimum of 3 to 5 years claims experience
  • LTC, disability, or related claims experience- claim adjudication experience or claim evaluation experience or some similar job responsibilities in your background
  • Professional designations, RN/LPN a plus but not a must have
  • Solid knowledge of Microsoft Office Products
  • Excellent verbal, written and presentation skills
  • Ability to learn new system applications quickly

This CM position pays 45k annually (equals 21.63/hr). The fulltime position (with great benefits) is based in Framingham, MA. Please send me your updated resume if you have interest or let me know if you have any recommendations.


Thanks in advance!



Shelley Johnson, Director Healthcare Solutions

The Newell Group

**Please email resume prior to calling.**