Disability Claims Examiner

The Disability Claims Examiner is in charge of reviewing, deciding, and handling disability claims in line with policy rules, regulatory requirements, and organizational standards. This job makes sure that claims are handled correctly, on time, and in accordance with the law while also providing professional and caring service to claimants, employers, and medical providers. The Disability Claims Examiner is very important for keeping risk management, regulatory compliance, and customer experience in balance.

Main Duties:

Look over, study, and decide on claims for short-term and/or long-term disability

Use the policy language, medical records, and job information to figure out who is eligible and what benefits they can get.

Ask for, look over, and make sense of medical records, employer statements, and other supporting documents.

Tell claimants and stakeholders about claim decisions in a clear and professional way.

Keep claims management systems up to date and correct with their records.

Make sure you follow all federal and state laws that apply, including ERISA when it applies.

Work with doctors, career counselors, and departments within the company

Keep track of claim inventories to make sure they meet service level and productivity standards.

Find possible fraud, chances to get money back, or times when a claim needs to be raised.

Take part in ongoing training, audits, and reviews of quality assurance

Necessary Qualifications:

A bachelor's degree in business administration, healthcare administration, human resources, or a related field (or equivalent work experience)

At least 3 to 5 years of experience managing disability claims, insurance claims, or benefits

A lot of knowledge about disability insurance policies and how to handle claims

The ability to look at medical and job-related information

Great skills in both writing and speaking

Good at organizing and paying attention to details

Ability to work alone in a place that is far away

Knowledge of Microsoft Office Suite and claims management systems

Preferred Qualifications:

Experience with disability plans that are governed by ERISA

Professional certifications like CEBS, LOMA, or certifications for filing disability claims

Experience handling claims for short-term and long-term disability

Knowing the rules about disabilities at the state and federal levels

Pay for the Year:
Salary Range: $65,000 to $95,000 a year, depending on where you live, how much experience you have, and what certifications you have.

Benefits Package:

Full coverage for medical, dental, and vision care

401(k) retirement plan with a match from the company

Paid time off (PTO) includes vacation days, sick days, and paid holidays.

A fully remote work arrangement in the US

Ongoing support for professional development and certification

Insurance for life and short- and long-term disabilities

Programs for employee health and well-being