Senior Disability Representative

Role Overview

• To provide disability case management and claim determinations based on complex medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments, medically managing disability claims.
• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.
• Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).
• Communicates with the claimants providers to set expectations regarding return to work.
• Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
• Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.
• Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.
• Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.
• Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
• Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
• Negotiates return to work with or without job accommodations via the claimants physician and employer.
• Refers cases as appropriate to team lead and clinical case management.
• Maintains professional client relationships.

Requirements

• Bachelor's degree from an accredited university or college preferred.
• Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures.
• Working knowledge of medical terminology and duration management.
• Excellent oral and written communication, including presentation skills.
• PC literate, including Microsoft Office products.
• Analytical and interpretive skills.
• Strong organizational skills.
• Ability to work in a team environment.
• Excellent negotiation skills.
• Ability to meet or exceed Performance Competencies.

Benefits

• Paid time off
• Flexible work arrangements
• Professional development opportunities