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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