Disability Claims Job Description
Disability claims
provides assistance to employees who are eligible for STD, LTD and FMLA benefits, by partnering with TPA, HRBPs and legal, where applicable.
Disability Claims Duties & Responsibilities
To write an effective disability claims job description, begin by listing detailed duties, responsibilities and expectations. We have included disability claims job description templates that you can modify and use.
Sample responsibilities for this position include:
STD) Reviews and assesses claim details and contract provisions to determine whether or not to accept liability
Administers Family & Medical Leave Act (FMLA) standalone claims (related to childcare, family member illness/injury or employee illness/injury not associated with a Group Disability claim)
Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, and Social Security
Respond to various written and telephone inquiries, including requests for and receipt of information the status of claims
Identifies and communicates claims trends and issues to management
Identifies process inefficiencies and cost reductions
Utilize referral resources and vendors appropriately to manage claim costs throughout the life of the claim
Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect)
Apply and analyze technical contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements and liability decisions
Verify on-going liability and develop strategies for return to work opportunities as appropriate
Disability Claims Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for Disability Claims
List any licenses or certifications required by the position: RG146
Education for Disability Claims
Typically a job would require a certain level of education.
Employers hiring for the disability claims job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Associates, Medical, Management, Administration, Business, Education, Nursing, Legal, Psychology, Business/Administration
Skills for Disability Claims
Desired skills for disability claims include:
FMLA regulations
Medical terminology
ERISA
LTD
STD
Group disability
Legal liability
Social security
Workers compensation
State laws
Desired experience for disability claims includes:
Responsible for applying appropriate risk management strategies and delivering superior service to our Clients
Three + years of insurance industry knowledge and experience are required
Demonstrated knowledge of insurance home office environment internal operations required
Knowledge of related regulations and standards that would apply to the products/procedures that the team works with is required
Ability to resolve complex situations by applying demonstrated knowledge and skills generally acquired through job experience
Must be able to communicate effectively with internal and external customer
Disability Claims Examples
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Disability Claims Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of disability claims. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for disability claims
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect)
- Coordinates investigative efforts ensuring appropriateness
- Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities
- Negotiates settlement of claims up to designated authority level
- Partners with Team Leader to ensure contingency plans are in place to achieve results when challenges arise (staffing shortages, new business, system implementation)
- Stays abreast of ongoing trainings associated with role and business unit objectives, ensuring staff is updated on role-appropriate trainings
- Works with business partners to ensure successful implementation of new accounts changes on additional lines of business with existing accounts
- Establishes & communicates performance standards & objectives, conducts performance appraisals
- Recommends/approves salary adjustments, promotions, transfers & dismissals
- Counsels team members on educational & job opportunities which will enhance their career development, & keeps staff informed of current problems, changes, & new developments in the department & company by conducting periodic meetings
Qualifications for disability claims
- Adjudicates and manages long term disability claims in a team-oriented, multi-disciplinary environment
- Past experience demonstrating proficiency in Microsoft Office products including Word, Excel, and Outlook required
- One year of insurance industry experience required
- Adjudicates and manages Short-term disability claims in a team-oriented, multi-disciplinary environment
- Registered Nurse (RN) with current Pennsylvania license
- 5 + yrs of experience in disability claims the directly aligns with the specific responsibilities for this position, including 2+ years of managerial, supervisory, and/or demonstrated leadership experience
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Disability Claims Job Description
Job Description Example
Our innovative and growing company is hiring for a disability claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for disability claims
- Controls expenses to meet the Branch Claim budget, & keeps expenditures to a minimum
- Assists in establishing Branch Claim office objectives supportive of Home Office Claim & corporate objectives
- Provides assistance in the selection & evaluation of vendors (i.e., defense attorneys, medical examiners, independent adjusters, & auto appraisers)
- Services TPA accounts as required
- Operates, inputs & retrieves information using the Focus System & Claim Workstation
- May assist in the training of staff in the operation & uses of the automated Focus System & Claim Workstation
- Keeps Service Center Manager informed verbally & in writing of activities & problems within assigned area of responsibility
- May be assigned to provide guiAbility to gather/analyze information from multiple sources to make decisions
- Developed knowledge and skills in a variety of work processes through formal training and considerable work experience
- Developed the skills to be responsible for analyzing disability claims, understanding rider language and determining appropriate claim requirements based of a claim’s facts
Qualifications for disability claims
- Responsible for applying appropriate risk management strategies, which will impact on the company’s financial results, reputation and regulatory risks, client relationships, and business retention
- Previous experience processing disability claims
- Monitors other sources of income that coordinate with Short Term Disability Benefits
- Broad knowledge of Disability products, philosophies, processes and markets, product marketing and distribution is strongly preferred
- Minimum of 2 years disability claims management experience and knowledge of disability claims payment systems preferred
- Knowledge of Claims coverage and case management procedures required
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Disability Claims Job Description
Job Description Example
Our company is looking to fill the role of disability claims. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for disability claims
- Must have excellent verbal and listening skills, be detailed oriented and have the desire and ability to provide customer service in a professional positive manner while maintaining an empathetic voice with the customer/agent
- Takes ownership of complex cases and escalates to management as appropriate
- Works autonomously within established guidelines with a limited degree of supervision
- Serves as a mentor and provides support to colleagues
- Adheres to Fair Claims Practices, regulations, NYL Claims service standards, Delegation of Authority and Corporate policies
- Communicates with claimants, employers, attorneys and various medical professionals to gather information that will assist in rendering a final appeals determination
- Conducts investigations to determine whether to uphold or overturn appeals
- Responds to various written and telephone inquiries
- Evaluates and refers appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care and Fraud
- Manages claims within multiple funding arrangements and for all five claim offices
Qualifications for disability claims
- Strong overall knowledge of Group Market departments and processes preferred
- Successful candidates will be required to pass enhanced RCMP security clearance
- 3 – 5+ years of experience in insurance claims that directly aligns with the specific responsibilities for this position OR For candidates with an Associate’s Degree or above, 1+ year of claims experience that directly aligns with the specific responsibilities for this position
- College degree and prior claim experience preferred
- Expectation of increasing levels of skill and ability
- Incumbent is expected to begin pursuit of industry related coursework towards a professional designation (ALHC, ACS, FLMI)
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Disability Claims Job Description
Job Description Example
Our growing company is looking for a disability claims. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for disability claims
- Intake and Processing of Family & Medical Leave Act (FMLA) standalone claims (related to childcare, family member illness/injury or employee illness/injury not associated with a Group Disability claim)
- Provides training, guidance, and assistance to field personnel
- Manage through front line claims managers
- Analyze the changing pattern of disability claim incidence/leaves and recovery patterns within assigned products and take corrective action to manage both within acceptable tolerances
- Ensure all areas are appropriately staffed
- Ensure appropriate service is provided to corporate customer representative
- Oversee the installation of business, including setting of staffing levels (in conjunction with unit managers), review of plan and identification of key issues
- Accountable for staff development by identifying developmental needs, QA trends, and opportunities and working with staff throughout development and appropriate training
- Implements new and revised policies and procedures, including ensuring operational compliance with federal/state requirements as applicable
- Performs additional duties and/or is assigned special projects as requested and operationalizes these projects in assigned unit as appropriate
Qualifications for disability claims
- Requires a high school diploma or its equivalent with at least 5 years of experience in the field or in a related area
- Minimum of5 years experience in disability claim management
- Bachelors Degree and 10 or more years of experience in the managing multiple lines of claims area
- Bachelor's degree with 1+ years of experience prefered, but not required, or a high school diploma or equivalent with 3+ years of related work experience
- Five or more years of progressive experience as a Claim Technician, or the equivalent, demonstrating the technical expertise to handle the most complex cases with a high degree of judgment & discretion
- Physical requirements are those of light or sedentary work, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects
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Disability Claims Job Description
Job Description Example
Our innovative and growing company is searching for experienced candidates for the position of disability claims. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for disability claims
- Assist in timely and effective investigation, analysis and solutions to complex disability claims payment issues, including systemic issues which may have existed for several years
- Prioritize multiple requests of varying urgency on an ongoing basis
- Complete all work with high attention to detail and accuracy
- Build and maintain effective working relationship
- Work collaboratively with both internal and external business partners
- Identify and suggest opportunities to process improvements
- Use critical thinking skills to investigate eligibility of coverage, evaluate claimant’s functionality, assess potential for return to work and other income benefits while providing exceptional customer service
- Work in a team environment and welcome feedback from their mentors and managers and as they continue to develop their skills
- Daily assignment of new claims to team members within respective Regional Claims Center according to training level and current queue work load
- Establishes priorities and communicates daily direction to the team members within their Regional Claims Center
Qualifications for disability claims
- Adjudicates and manages disability claims in a team-oriented, multi-disciplinary environment
- 1-3 yrs of experience in training that directly aligns with the specific responsibilities for this position
- 5 + yrs of experience in short term disability claims that direcly aligns with the specific responsibilities for this position, including 2 + years of managerial, supervisory, and /or demonstrated leadership experience
- You have over 10 years of experience handling complex disability claims
- You have experience working with disability claims in a unionized environment
- A minimum of 2 years of disability claims experience required in a related field