Senior Claims Administrator

Position Summary: Incumbent is responsible for managing a caseload of long term disability claims including the benefit payment, risk management and customer service associated with the caseload. This requires applying the appropriate policy provisions and department procedures to the medical and occupational facts of each claim to determine if benefits are payable or not payable.


 


Position Responsibilities:


Reviews claim payments within established authority limits and manages a group of claims on an ongoing basis to ensure appropriateness of payment of benefits. Manages claims activities and appropriate use of resources to ensure that payouts are adjudicated in a timely, accurate and efficient manner:


1. Conducts initial claim eligibility review;


2. confirm that medical evidence supports claimant's restrictions & limitations;


3. develop and document claim strategy for ongoing claim management of each file;


4. Prioritize caseload and work;


5. Assess occupational job duties and rehabilitation opportunities by working with vocational staff;


6. Appropriately uses investigative tools. May testify in court cases, respond to State Insurance Department complaints/requests and provide depositions related to claim disputes based upon technical expertise.



Position Requirements:

1. Excellent written and verbal communication skills.

2. Other related work experience in claims or in a medical field would be helpful, particularly in the areas of worker's compensation, long term care or medical claims.

3. Must be able to work in a team environment.

4. Ability to speak directly with claimants in telephone interviews or in person with other Senior Analysts.

5. Solid analytical skills as well as the ability to negotiate with people