LTD Claims Analyst - SER8261

l. Job Summary: This position will provide accurate claims adjudication and

superior customer service for Long-Term Disability recipients.

This is part of our absence management support for the operation

of CDMI Disability Solutions accounts.

II. Accountabilities:

Investigates, secures and analyzes information pertaining to

claimants medical condition, occupational demands, eligibility status

and other policy provisions to determine entitlement to disability benefits.

Identifies discrepancies and outstanding issues and secure

additional information while investigating within the timeframes established

by policy and procedures.

Applies federal, state and local laws and regulations affecting

claim investigation, disability decision, claim payment and taxation of benefits.

Interprets customer's long-term disability plan and contract.

Calculates, approves and denies proper benefit payment amounts.

Produce objective, clear documentation and technical rational for

claim decisions, appeals and complaints.

Gathers documentation needed to review analyze and accurately

settle claims according to policy provisions and state regulations.

Provides on-going claim management activities to appropriately

contain claim liability; ensures that claimant's medical condition is ongoing,

applicable policy limitations and provisions, and deductible income are

investigated, pursued and applied, and used to reach timely and appropriate

claim resolutions, so claims are managed to the correct payment duration.

Accepts accountability for other duties and special projects as assigned.

 

III. Job Requirements:

Bachelor's degree and 2 years of group disability (LTD) experience

is required. In lieu of a degree, incumbent must have 5+ yrs of Long Term

Disability group. Professional claims designations desired.

Strong knowledge of group long term disability contracts to ensure

consistent claim determinations

Strong analytical thinking, problem solving, and decision making,

and math skills.

Ability to recognize multiple connections to reach appropriate and timely

claim determinations.

Strong medical knowledge is desired in order to partner with internal

medical professionals; RN's, Vocational Rehab Consultants, Physician's, etc.

Work with Human Resource professional's and other company leaders

on self-insured customers.

Ability to prepare system reports and analyze data to ensure accurate

records.

Ability to work in a fast-paced environment, where strong time management

and organizational skill are essential.

Quality business writing skills are necessary.

 

 

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