About the position
The Long Term Disability (LTD) Claims Examiner will be responsible for managing an assigned caseload of Long Term Disability claims, which involves overseeing claims that may have longer durations and evolving medical conditions. This role requires the candidate to engage in meaningful and transparent conversations with customers and clinical partners to gather relevant information for each claim. The position also entails performing potentially complex benefit calculations on a monthly basis, evaluating customer eligibility, and interacting with a variety of stakeholders including customers, employers, physicians, internal business partners, and attorneys to make informed decisions regarding claims. In this role, the LTD Claims Examiner will proactively manage their block of claims by maintaining regular communication with customers to understand their level of functioning and to have a comprehensive grasp of the case facts. The candidate will be expected to develop and document Strategic Case Plans that focus on the future direction of each claim, utilizing a holistic viewpoint. They will review contractual language and medical documentation to determine customer eligibility, interpret information, and make decisions based on the facts presented. The position also involves leveraging a claim dashboard to manage claim inventory effectively, identifying which claims to prioritize for maximum impact. The LTD Claims Examiner will engage in discussions with customers and employers about return-to-work opportunities, adopting an action-oriented approach. They will work closely with clients and Vocational Rehabilitation Counselors to facilitate return-to-work arrangements, whether on a full-time or modified duty basis. The role requires asking focused questions to internal and external resources to clarify discrepancies and ensure accurate claim management. Additionally, the LTD Claims Examiner will be responsible for executing client performance guarantees, responding to communications in a clear and timely manner, and making fair, accurate, and quality claim decisions while adhering to standard processing timeframes. The candidate will also support integration initiatives related to Family Medical Leave, Life Assistance Programs, and other health-related programs, while ensuring compliance with corporate policies and best practices. Continuous training and staying updated with role-related objectives are also essential components of this position.
Responsibilities
- Manage an assigned caseload of Long Term Disability claims.
- Engage in meaningful conversations with customers and clinical partners to gather relevant information.
- Perform complex benefit calculations on a monthly basis.
- Evaluate customer eligibility and interact with various stakeholders to make claim decisions.
- Proactively manage claims by maintaining regular communication with customers.
- Develop and document Strategic Case Plans focusing on the future direction of claims.
- Review contractual language and medical documentation to determine customer eligibility.
- Leverage claim dashboard to manage claim inventory effectively.
- Discuss return-to-work opportunities with customers and employers.
- Work with clients and Vocational Rehabilitation Counselors to facilitate return to work.
- Ask focused questions to clarify discrepancies and ensure accurate claim management.
- Execute client performance guarantees and respond to communications in a timely manner.
- Make fair, accurate, and quality claim decisions adhering to processing timeframes.
- Support integration initiatives related to health programs and compliance with corporate policies.
Requirements
- High School Diploma or GED required; Bachelor's degree strongly preferred.
- Long Term Disability Claims experience preferred.
- Experience in hospital administration, medical office management, financial services, or business operations is a plus.
- Excellent organizational and time management skills.
- Strong critical thinking abilities.
- Technically savvy with the ability to toggle between multiple applications and computer monitors.
- Proficiency with MS Office applications (Word, Outlook, Excel).
- Strong written and verbal communication skills.
- Experience with collaborative negotiations.
- Proven skills in positive and effective customer interaction.
- Ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
Nice-to-haves
- Experience in effectively meeting/exceeding personal professional expectations and team goals.
- Comfortable giving and receiving feedback.
- Flexible to change.
- Demonstrated analytical and math skills.
Benefits
- 401k
- Medical
- Dental
- Vision
- Tuition Reimbursement
- Student Loan Repayment
