Short Term Disability Claims Specialist

Job Description

REQUIREMENTS

• High school diploma or GED equivalent.
• A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
• Strong communication skills
• Critical-thinking, strategic-thinking, and prioritization skills
• Ability to give and receive feedback using specific measurements and observed behavior as well as openness to receiving feedback

Preferred

• Associate Degree

• 2 plus years of claims management experience preferably in Healthcare field

• Proficient in Microsoft Word/Excel
• Expertise knowledge of system and tools, ie…MDG, DPA, Intellis and how to leverage tools to improve claim management effectiveness

RESPONSIBILITES

• Applies all appropriate provisions of the disability contract to ensure that our client’s liability is understood and appropriately applied throughout the life of the claim. Within the context of liability, encourage and support return to work through a variety of programs and methodologies.
• Proactively communicates with the claimant to set expectations, assess medical and non-medical barriers to return to work, and keep him or her fully aware of the status of the claim, including setting expectations with the claimant if other resources (Voc, etc.) will be contacting him/her.
• Partners with the claimant, specialty resources, and more experienced resources to ensure that each claim has a well-understood plan that is appropriate for the unique situation of each claimant, his or her functional capacity and the prognosis for an increase in that capacity. Proactively updates partners that may be working with the claimant when key events are being considered or have occurred. (closure, RTW, etc.).
• Manages overall block of assigned claims, including prioritizing actions, appropriately utilizing resources, and timely and accurate decision. Executes individual claim action plans, serves as point of contact for the claimant, and makes claim decisions.
• Provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication.

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