Claim Analyst 3

Job Description

REQUIREMENTS

• High school diploma or equivalent plus 6+ years work experience.
• Bachelor’s degree or associate degree with legal and or medical terminology, or prior Life and Disability claim experience preferred.
• Ability to maintain a high degree of accuracy and pay strict attention to detail.
• Must be able to work in a team environment.
• Good analytical, interpersonal, problem solving and decision-making skills.
• Ability to maintain confidentiality.
• Good verbal and written communication skills (must be able to connect with individuals experiencing illnesses, financial losses, or deaths of loved ones as well as legal and/or medical professionals).

RESPONSIBILITES

• Review, analyze, manage, and make appropriate and accurate decisions on Life and/or Disability claims in accordance to policy and state/federal law and regulations. Mentor, counsel, and provide feedback and assistance to others.
• Analyze, investigate, and adjudicate disability claims after determining information needed and acquiring all appropriate information. Analyze medical, vocational, and financial information to make effective and timely claim decisions. This includes having an in-depth knowledge of claim procedures, product design, contract provisions, state laws and recognition of rehabilitation and Social Security potential. Maintain fully detailed claim file providing a clear and understandable audit trail required for compliance and legal purposes. Identify and refer claims to other resources (senior claims personnel, Medical, Law, etc) with appropriate action plan and questions.
• Connect with clients regarding medical conditions, restrictions & limitations, disability policy provisions, claim decisions, and all other aspects of the claim process.
• Optimally manage caseload as well as assist others in coordinating, setting priorities, providing feedback and supervising their caseload to ensure company and state/federal requirements are met.
• Provide technical insight and be a resource to internal staff and others outside the claim function for claim contract issues. Counsel Team members, providing guidance in claims administration. Serve as consultant to underwriters, customer service, and producers regarding the administration of policy provisions.
• Perform other job-related duties and special projects as the need arises.

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