Disability Benefit Specialist

• Manages assigned caseload of disability claims for Short Term/Long Term Disability.


• Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.


• Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.


• Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.


• Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.


• Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.


• Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards


• Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.


• Analyzes claims activity and prepares reports for clients/carriers and management as needed


• Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.


• Effectively works together in a team setting.


• Other duties as assigned.

• Bachelor's degree or equivalent experience required.
• 2 + years of STD/LTD claims adjudication
• Experienced in the TPA or self-administration services is desired
• Experience with FMLA/State leave claims is a plus
• Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
• Ability to work independently while assimilating various technical resources
• Computer knowledge in excel, word, web based systems, etc
• Good verbal and written communication skills
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
• Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
• Strong ability to identify, analyze and solve problems.
• Effective interpersonal skills capable of dealing with external sources and all levels of employees.

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