Disability Claims Resume Samples

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SS
S Schimmel
Saul
Schimmel
4199 Demond Parkway
Dallas
TX
+1 (555) 247 7673
4199 Demond Parkway
Dallas
TX
Phone
p +1 (555) 247 7673
Experience Experience
New York, NY
Disability Claims Manager
New York, NY
Kub-Jakubowski
New York, NY
Disability Claims Manager
  • Support the Director in developing and implementing business plans
  • Identify and implement ongoing productivity and service enhancements
  • Work with union representatives for both WSIB and Benefits to facilitate proper case management for unionized employees
  • Serve as lead technician and subject matter expert on difficult and complex cases, and on Company practices and procedures
  • Review and approve key claim decisions and provide direction for the management of claims
  • Provides technical direction to claim team members on claims adjudication for LTD Claims
  • Perform claim audits within the team, identify opportunities and develop and implement action plans to address opportunities/findings
Philadelphia, PA
Long Term Disability Claims Manager
Philadelphia, PA
Hessel and Sons
Philadelphia, PA
Long Term Disability Claims Manager
  • Manages both new claims and open claims equally and maintains decision times
  • Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
  • Adheres to standard timeframes for processing mail, tasks and outliers
  • Stays abreast of ongoing trainings associated with role and business unit objectives
  • Pays all covered claims accurately and timely
  • Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
  • Responsible for staffing within the unit, including selection, retention, career development and performance management
present
Phoenix, AZ
Short Term Disability Claims Manager
Phoenix, AZ
Collier Inc
present
Phoenix, AZ
Short Term Disability Claims Manager
present
  • Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
  • Exhibits claim management performance according to quality and compliance standards
  • Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
  • Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
  • Executes on all customer performance guarantees
Education Education
Bachelor’s Degree in Customer Service
Bachelor’s Degree in Customer Service
New York University
Bachelor’s Degree in Customer Service
Skills Skills
  • Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources
  • Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
  • Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
  • Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
  • Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Pay all covered claims accurately and timely
  • Execute on all customer performance guarantees
  • Adhere to standard timeframes for processing mail, tasks and outliers
  • Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
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11 Disability Claims resume templates

1

Senior Disability Claims Specialist Resume Examples & Samples

  • Responsible for the adjudication of disability claims utilizing a multidisciplinary claim management model to
  • Ensure objective, fair and thorough claim adjudication
  • Comply with practices and procedures and regulatory requirements
  • Provide the highest level of customer service and manage reputational risk
  • Read, validate and interpret financial statements and tax returns and apply to the decision-making process
  • Effectively communicate and build rapport with team members, stakeholders and business partners using a variety of techniques and collaboration from initiation to close
  • Resolves the more complex conflicts and issues and escalates to others as appropriate
  • Minimum of 3 years of directly relevant disability claims experience
  • Minimum of one industry course completed, three preferred and working toward an industry designation (e.g. ALHC, FLMI, HIAA)
  • Ability to multitask and balance multiple goals and priorities
  • Demonstrated ability to effectively deal with customers in a manner that is professional with a high degree of customer service
  • Bilingualism in both French and English, written and spoken is considered an asset for this role
2

Disability Claims Analyst Resume Examples & Samples

  • Responsible for assigned long term disability claims utilizing a multidisciplinary claim management model to
  • Ensure objective, fair and thorough claim adjudication
  • Comply with practices and procedures and regulatory requirements
  • Provide the highest level of customer service and manage reputational risk
  • Develop and implement claim management and return to work strategies for their assigned caseload
  • Recognize and investigate complex issues and escalate, when appropriate these issues to their mentor, Lead or manager
  • Effectively manage multiple client needs and internal job demands
  • Strong analytical and decision making skills
  • Ability to multitask and balance multiple goals and priorities
  • Demonstrated ability to effectively deal with customers in a manner that is professional with a high degree of customer service
  • Ability to effectively manage change
3

Disability Claims Specialist Resume Examples & Samples

  • Develop and implement claims management and return to work strategies on their assigned caseloads
  • Given the very sensitive nature of the information gathered in the adjudication process, extreme care must be exercised in the handling of a claim in order to guard against any breach of confidentiality
  • Assesses, researches and analyzes numerous disability contracts. Documents the appropriate next steps while effectively applying the adjudication process. Professionally communicate outcomes to our clients
  • Resolves more complex conflicts and issues and escalates to others as appropriate
  • Post secondary education
  • Minimum of 2 years of directly relevant disability claims experience
  • Working on one industry course, one course completed preferred and working toward an industry designation (e.g. ALHC, FLMI, HIAA)
  • Experience in effectively managing more complex claims
  • Proven skills in conflict resolution
  • Ability to effectively manage change
  • Fluency in both English and French (written and spoken) would be considered an asset for this role
  • LI-DC1
4

Team Lead, Short Term Disability Claims Resume Examples & Samples

  • Demonstrated leadership skills a must
  • Supervisory experience preferred, but not required
  • Prior experience with Claim Management processes
  • Ability to problem solve independently
  • Demonstrated focus on continuous improvement
  • Strong communication (verbal and written) and time management skills required
  • Proficiency in MS Word and Excel
  • Demonstrated strong Customer Service skills and ability to partner
  • Understanding of Absence, STD and LTD product lines with experience of at least five plus years in absence/disability claim organization preferred
5

Manager, Disability Claims Resume Examples & Samples

  • Experience managing Short Term and Long Term Disability claims
  • Experience in disability appeals preferred
  • Litigation experience (depositions, mediations)
  • Supervisory/Management experience, including proven staff development skills
  • Effective written and oral communication to both internal and external customers
  • Proven ability to effect organizational change
  • Experience in Process redesign efforts
6

Group Disability Claims Director Resume Examples & Samples

  • Effective collaboration with multiple business partners across and outside of the organization in the development and execution of comprehensive insurance and disability management strategies including technology and data management solutions that result in RBC Life attaining a profitable position in the market as the preferred Group Benefits Solutions carrier of choice.,
  • Leading, coaching and developing a team of Disability Claim Managers and individual contributors to achieve personal and team success,
  • Consistent execution of effective claim management routines aimed at driving improved client health and wellness outcomes,
  • Driving best in class client service delivery to attract and retain profitable business
  • Strong focus on the management of multiple to risks: legal, legislative and reputational,
  • Management of the operational excellence standards required to mitigate legal, regulatory, compliance, anti-money laundering, terrorism and reputational risks
  • Strategic Direction: Contribute proactively and effectively as a member of the Life and Health Claims team. Contribute to creating the strategic direction for the Group Disability Product and Claims management practices and procedures. Assist in developing the Group Division business plan and overseeing the execution of tactics with objectives to: increase potential for profitable growth, and increase market share
7

Manager, Disability Claims Resume Examples & Samples

  • Providing reports and analysis of trends
  • Attending meetings with business partners
  • Flexibility to manage a modified assignment when business needs dictate due to volume or for absence coverage
  • RN designation, or appropriate credentials in either Physical or Occupational Therapy is required
  • 7-10 years of relevant clinical and or industry experience
  • Prior experience as a leader of people is highly desirable
  • Ability to lead, facilitate and participate in relevant department, division and GI projects and meetings
  • Must possesses excellent analytical skills, creative thinking and courage
  • High level of organizational awareness
  • Ability to partner effectively with all levels of claim and clinical/vocational staff and management
  • Excellent communication, presentation and time management skills
8

Life & Disability Claims Auditor Resume Examples & Samples

  • Performs audits of and may adjudicate high dollar claims while maintaining acceptable levels of claims inventory and age
  • Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable
  • Refers overpayment opportunities to Recovery Team
9

Short Term Disability Claims Analyst Resume Examples & Samples

  • Ensures claims integrity and compliance with established procedures, timing requirements and regulatory guidelines
  • Monitors other sources of income that coordinate with Short Term Disability Benefits. Can calculate, explain, and recover overpayments on disability claims
  • Coordinates with Long Term Disability Claims team when benefits integrate
10

Disability Claims Manager Resume Examples & Samples

  • Overall responsibility for performance of the team, including ensuring thorough, fair and objective claim evaluations and decisions, and providing the highest level of service to our customers
  • Serve as lead technician and subject matter expert on difficult and complex cases, and on Company practices and procedures
  • Review and approve key claim decisions and provide direction for the management of claims
  • Triage and monitor work/caseload within the unit to ensure that staff is assigned an appropriate caseload
  • Responsible for staffing within the unit, including selection, retention, career development and performance management
  • Perform claim audits within the team, identify opportunities and develop and implement action plans to address opportunities/findings
  • Support the Director in developing and implementing business plans
  • Implement and effectively manage change
  • Identify and implement ongoing productivity and service enhancements
  • Leads projects and initiatives across Life and Health Claims
  • Responsible for ensuring that all complaints and appeals within the unit are responded to appropriately and within service standards
  • Ensure effective utilization of resources in order to maintain cost effective and appropriate risk management activities
  • Responsible for reviewing key management reports and developing action plans to address issues and variances, including risk management and customer service issues
11

Disability Claims Assistant Resume Examples & Samples

  • Assist Short Term Disability Case Managers, Long Term Disability Case Managers, Disability Claims Technical Specialists, and/or Claims Technicians with their daily tasks in an effort to help deliver a superior customer experience
  • Complete timely follow-up requests and inquiries for medical records or other pertinent information
  • Communicate with claimants, employers, and various medical professionals / vendors to gather information regarding the application for and ongoing management of disability benefits
  • Respond to various written and telephone inquiries, including requests for and receipt of information as well as the status of claims
  • Issue accurate payment of vendor invoices for various claim specific requests including medical records and medical examinations
  • Continually and accurately document our claim system and claim files on actions taken
  • Strong typing / keying skills required
  • Excellent telephonic communication and customer service skills applied to elicit information and convey information to a variety of audiences clearly, succinctly and diplomatically
  • Excellent organizational skills to manage multiple priorities and tasks
  • Strong written communication skills to accurately and clearly capture claims status, actions taken and decisions made
  • Ability to work independently and as a member of a team to achieve individual and team objectives
  • Knowledge of and experience with data entry and Microsoft Office Suite applications (Word, Excel, Outlook) required
  • 2-5 years of experience in the customer service and / or insurance industry is preferred
12

Disability Claims Consultant Resume Examples & Samples

  • Assess appeals that have reached the 2nd level of the appeal process at Sun Life Financial
  • Govern the critical financial components related to overpayments
  • Contribute to the effectiveness of our Quality Management program by ensuring process adherence and accuracy to quality controls
  • Liaise with the Office of the Ombudsman in responding to plan member concerns with respect to customer service and claim decisions
  • Coach and mentor Disability Case Managers, regarding quality case management ensuring that all components including the contract, medical, functional and vocational components are considered as part of the overall assessment of the claim decision
  • Demonstrate an excellent knowledge of group insurance, disabilities and claims management strategies
  • Exhibit solid communication, organizational and people skills in order to effectively drive positive case management outcomes
  • Ensure a client focused approach permeates in your coaching as you mentor both Case Managers and Case Management Consultants, on the disability and financial risks associated with disability claims management
  • Contribute to a dynamic work environment by identifying opportunities to continuously improve processes to better meet our service excellence, quality and financial commitments to our customers
  • Contribute to the ongoing business retention and growth by cultivating excellence in your team
  • Manage second level appeals in accordance to our claims practices, procedures adhering to our philosophies and principles, within the services standards set for the organization
  • Review weekly governance reports to ensure compliance with practices and processes. Work with claims operation to take further action on claims as needed
  • Co-ordinate Quality Management Review Activity
  • Provide suggestions to improve the client experience through the 2nd level appeal process by participating in initiatives to review current processes to identify opportunities to improve the processes or improve team consistency
  • Work with Team Managers to identify and close any gaps on case management deficiencies that surface through coaching
  • Provide feedback and direction to the Abilities Case Manager on continuously improving their case management skills
  • Partner with other Portfolio Business Experts, Case Management Consultants and Trainers to facilitate continuous professional development within the region, where appropriate
13

Manager, Short Term Disability Claims Resume Examples & Samples

  • Approves and makes more complex claim management related financial decisions consistent with company guidelines for assigned area(s) of responsibility
  • Collaborates with internal and/or external stakeholders to ensure effective service delivery of more complex claims for assigned area(s) of responsibility
  • Collaborates with sales offices to ensure effective service delivery of claims for assigned area(s) of responsibility
  • Completes regular quality audits of assigned area(s) of responsibility claim/team members' work; records results and counsels staff to bring work to or above standards
  • Ensures all assigned area(s) of responsibility claims, eligible or ineligible for payment, conform to quality, production standards and specifications
  • Ensures claims processing is consistent with applicable policies, procedures and department guidelines for assigned area(s) of responsibility
  • Identifies and communicates claims trends and issues to management. Develops mitigation plans
  • Identifies process inefficiencies and cost reductions. Develops and recommends mitigation plans
  • Manages the processing and administration of all aspects of more complex claims for his/her assigned area(s) of responsibility ensuring accurate and timely claim management
  • Monitors and evaluates overall metrics for team productivity and takes appropriate action to meet or exceed standards
  • Provides more complex technical guidance to claim team members on claims adjudication for assigned area(s) of responsibility
  • Reviews and resolves more complex escalated issues and concerns for assigned area(s) of responsibilities
  • Reviews regular quality audits of for assigned area(s) of responsibility claim team members work, analyzes results and counsels staff to bring work to or above standards
  • 5+ Years of experience in { Claims that directly aligns with the specific responsibilities for this position, including 2+ years of managerial, supervisory, and/or demonstrated leadership experience(Required)
  • 4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) in Insurance (Minimum Required)
14

Senior Manager Short Term Disability Claims Resume Examples & Samples

  • Manage claims and customer service activities to optimize and sustain sound risk analysis, performance, profitability and customer satisfaction
  • Responsible for the leadership and development of the team of Claims examiners
  • Develop, implement, and evaluate procedures to correct identified issues leading to more accurate, on-time claims service to the policyholder, increase the overall effectiveness and efficiency of the unit and ensure uniformity and consistency in all procedures
15

Senior Disability Claims Analyst Resume Examples & Samples

  • Manage client and advisor relationships over the individual disability claim life cycle
  • Determine claim requirements
  • Request and evaluate medical & financial information to reach claim decision
  • Handle claim referrals from team members and assist other analysts with claims as necessary
  • Coordinate investigative efforts ensuring appropriateness of referral of claims to internal resources and outside vendors
  • Disability team phone queue support
  • Understand regulatory requirements related to individual disability claim contracts
  • Provide input to improve process and procedures
  • Disability insurance claims experience
  • Associate (2-year) or equivalent with 3+ years of experience
  • Understanding of medical terminology, disability duration guidelines and medical management practices
  • Understanding of contract law
  • Excellent organizational skills and the ability to effectively prioritize tasks
  • College degree or equivalent with 3+ years of experience
16

Short Term Disability Claims Associates Resume Examples & Samples

  • Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims
  • Sets claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner
  • Obtains backup documentation, as necessary, to substantiate claim or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources
  • May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs
  • Must be able to utilize legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology in order to make final decisions to approve or further investigate claims
  • Bachelor degree with a minimum requirement of 3.0/4.0 GPA
  • 0-2 years of customer service experience
  • Excellent organization skills required due to the nature of internal and external contacts and exposure to highly confidential information
  • Proven ability to successfully cope in a fast-paced, demanding environment
  • End user computing skills, including proven proficiency in MS Office Outlook, Word, Excel and PowerPoint and Windows 7 with the ability to learn new and complex computer systems
  • Strong mathematical skills for calculations and adjustment of claim payments
  • Requires independent judgment to settle claims in accordance with policy provisions
  • Proven ability to work independently on own initiative and in a team environment
  • Demonstrated ability to work to deadlines with a high level of accuracy and attention to detail
17

Disability Claims Analyst Resume Examples & Samples

  • Review and render determinations on Long Term Disability claims
  • Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process
  • Respond to all inquiries generated relative to Long Term Disability claims within established service timeframe
  • Provide accurate claim decisions in accordance with Policy, State and Federal guidelines
  • Adjudicate Long Term Disability claims
18

Disability Claims Case Manager, Trainee Resume Examples & Samples

  • Make claim determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and using case management resources
  • Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation
  • Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
  • Bachelor’s degree with a minimum 3.0 cumulative GPA; additional requirements may apply
  • Proven track record through internships, co-ops or other business/leadership experience
19

Associate Disability Claims Case Manager Resume Examples & Samples

  • An opportunity to develop the knowledge, skills and capabilities needed to conduct investigations
  • Learn to make liability determinations
  • Understand how to manage group disability claims
  • Through the training program and on-the-job training, you will learn how to apply the appropriate contractual provisions, legal guidelines, case management resources and claim procedures, concepts, principles, and protocols to risk manage claims
  • Excellent ability to multi-task
  • Ability to demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills
  • Knowledge of insurance, medical terminology, and case management in same or similar discipline preferred
20

Z-se-disability Claims Case Manager, Trainee Resume Examples & Samples

  • An opportunity to develop the knowledge, skills and capabilities needed to conduct investigations
  • Understand how to manage group disability claims
  • Ability to demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills
  • Knowledge of insurance, medical terminology, and case management in same or similar discipline preferred
21

Associate Disability Claims Case Manager Resume Examples & Samples

  • Ability to gather/analyze information from multiple sources to make decisions
  • Excellent organizational skills to manage multiple priorities and tasks for large caseloads
  • Ability to work independently and as a member of a team to achieve individual and team objectives
  • Knowledge of and experience with data entry and Microsoft Office Suite applications (Word, Excel, Outlook) required
  • Knowledge of legal liability, insurance coverage or medical terminology preferred. a
22

Senior Disability Claims Consultant Resume Examples & Samples

  • Manage your litigated block of cases with a strong proactive customer service focus, exhibiting expert skill in both disability and litigation management and following relevant practices, processes, and guidelines
  • Represent Sun Life in a highly professional manner at mediations, examinations for discovery, pre-trials, trials, grievance arbitrations and at any other judicial or quasi-judicial proceeding
  • Instruct our legal counsel on the final disposition of litigated claims
  • Handle final level appeals and other escalated matters in thorough, timely and effective manner, following relevant practices and processes, again with a strong proactive customer service focus
  • Provide leadership in complex case management
  • Identify issues and solutions on both litigated and non-litigated cases that require follow-up within the disability operations
  • Consistently build strong working relationships with members of our legal services department, disability claims operations, and other stakeholders, working proactively and in partnership with them
  • Contribute to the ongoing business retention and growth by building strong working relationships with our customers and by your proactive engagement with all customers
  • Demonstrate an excellent knowledge of group insurance, and disability case management strategies
  • Build a strong knowledge of litigation management strategies
  • Exhibit strong communication, organizational and people skills
  • Help prioritize work in order to meet customer expectations
  • Work to improve your quality outcomes
  • Build strong, effective relationships with your manager, and other members of the litigation management team, working in partnership with them to help the team meet expected business outcomes
  • Coach and mentor other team members as opportunities arise
  • Create and deliver presentations to disability claims operations based on common trends within litigation or on other relevant topics
  • Take an ownership role in your own development
  • LI-WJ1
23

Disability Claims Case Manager Associate Resume Examples & Samples

  • For an assigned caseload of short-term disability claims, and in accordance with established procedures/protocols, apply appropriate contractual provisions, legal guidelines, and case management resources to make claim determinations
  • Bachelor’s Degree preferred, or relevant, progressively responsible practical experience required, to include at least two years in a customer service environment
  • Knowledge of legal liability, insurance coverage or medical terminology preferred
24

Disability Claims Manager Resume Examples & Samples

  • Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources
  • Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
  • Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
  • Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
  • Pay all covered claims accurately and timely
  • Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
  • Stay abreast of ongoing trainings associated with role and business unit objectives
  • Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
  • 1 year minimum of professional experience strongly preferred
  • HS Diploma or GED required. Bachelor’s degree strongly preferred
  • Proven track record of successfully driving results in a complex matrix environment is a (+)
  • Additional experience administering FMLA and/or State Leaves is a (+)
  • Ability to manage multiple and changing priorities
  • Knowledge of legal liability, insurance coverage and medical terminology is a (+)
25

Asst Life & Disability Claims Analyst Resume Examples & Samples

  • Obtain, analyze and investigate medical, financial and contractual information to make effective and timely claim decisions
  • Monitor and follow up on outstanding items to ensure compliance with regulations, service timing, and quality guidelines
  • Bachelor's degree with 1+ years of experience preferred, but not required, or a high school diploma or equivalent with 3+ years of related work experience
  • Ability to maintain a high degree of accuracy, pay strict attention to detail, maintain confidentiality, and work within the grey
  • Computer skills and typing proficiency
26

Disability Claims Manager Resume Examples & Samples

  • Manage and act as a liaison between Management/WSIB for all WSIB cases for any occupational Injuries/illnesses that occur on site
  • Manage all non-occupational injury/sickness claims with employees as well as 3rd party Insurance provider
  • Investigate and challenge fraudulent claims
  • Maintain a database of all occupational and non-occupational cases
  • Manage the successful Return To Work process and amend as needed
  • Manage the restricted workforce database and work with Managers to ensure the accommodation process is followed
  • Facilitate communication with on-site Health Centre to ensure proper flow of information regarding any claims and disability related items
  • Work with union representatives for both WSIB and Benefits to facilitate proper case management for unionized employees
  • Liaise with Benefits Administrator on all unionized claims where necessary
  • Support 2nd step grievance and arbitrations as required
  • You have a post-secondary education preferably related to Disability Management
  • You have over ten (10) years of experience handling complex disability claims
  • You have working knowledge of medical conditions, recovery guidelines and resulting restrictions/impact on function
  • You have working knowledge of WSIB regulations
  • You have working knowledge of Microsoft Office Suite
  • You have excellent organizational skills with the ability to prioritize, be flexible and multi-task
  • You have excellent communication skills (both verbal and written) and an analytical approach to problem solving
  • You will have experience working with disability claims in a unionized environment
  • You have demonstrated the ability to challenge the status quo,
27

Long Term Disability Claims Manager Resume Examples & Samples

  • Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
  • Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Execute on all customer performance guarantees
  • Manage both new claims and open claims equally and maintains decision times
  • Adhere to standard timeframes for processing mail, tasks and outliers
  • High School Diploma or GED required. Bachelor's degree strongly preferred
  • 1 year minimum of professional experience is strongly preferred
  • Experience in hospital administration, medical office management, financial services and/ or business operations is a (+)
  • Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
  • Proficiency with MS Office applications is required (Word, Outlook)
  • Strong written and communication skills demonstrated in previous work experience
  • Specific experience with collaborative negotiations
  • Proven skills in positive and effective interaction with challenging customers
  • Experience in effectively meeting/exceeding individual professional expectations and team goals
  • Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset. Must have Demonstrated analytical and math skills
28

Long Term Disability Claims Manager Resume Examples & Samples

  • Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
  • Executes on all customer performance guarantees
  • Exhibits claim management performance according to quality and compliance standards
  • Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed
  • Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
  • Mentors and coaches new hires as needed
  • Minimum of 18 months disability claim management experience
  • Ability to thrive in a fast-paced environment and meet deadlines
  • Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
  • Critical attention to detail
29

Long Term Disability Claims Manager Resume Examples & Samples

  • Adhere to standard time frames for processing mail, tasks and outliers
  • Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset
  • Demonstrated analytical and math skills
30

Short Term Disability Claims Case Manager Associate Resume Examples & Samples

  • Calculate liability for claims, applying appropriate offsets such as social security, workers compensation, and third parties
  • Continually and accurately document system and claim files on actions taken. Establish future action plan and case direction
  • Strong written communication skills to accurately and clearly capture claims status, actions taken and decisions made
31

Short Term Disability Claims Manager Associate Resume Examples & Samples

  • Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
  • Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation
  • Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
  • Excellent telephonic communication and customer service skills to elicit information and convey decisions to a variety of audiences clearly, succinctly and diplomatically
32

Manager, Disability Claims Resume Examples & Samples

  • Build a stable, collaborative team of disability management professionals through recruiting ideal candidates who will fit with our culture, have strong customer service focus and expert skill in disability management, and provide ongoing coaching for the team’s continued development
  • Build strong relationships with our Plan Sponsors, working in partnership with them to address their workplace absence issues
  • Demonstrate an excellent knowledge of group insurance, disabilities and claims management strategies
  • Exhibit solid communication, organizational and people skills in order to effectively manage client relationships
  • Act as the primary resource for your assigned team, giving staff direction on overall office targets, workload management, difficult cases, department workflow and processes
  • Proactively address clients’ needs and address complaints that may be escalated to you
  • Help your team to prioritize work items in order to meet client service standards and Sun Life best practice guidelines
  • Contribute to a dynamic work environment by identifying opportunities to continuously improve processes to better meet our service excellence, quality and financial commitments to our customers
  • Contribute to the ongoing business retention and growth by cultivating excellence in your team and continuous proactive engagement with your assigned clients to ensure full understanding of their evolving needs and how we can meet and exceed their expectations with respect to their group disability program
  • Performance management assessments for direct reports
  • Development and growth of team
  • Recruiting and resolution of employee performance issues
  • Quality assurance and achievement of service standards and monthly targets
  • Establishing and deepening client relationships as a primary representative of Group Disability for your assigned block of clients
  • Working with Business Development, you will sometimes be required to present at finalist presentations or act as a resource in developing our business
  • Foster a strong relationship with Business Development to support proactive client management for assigned clients
33

Disability Claims Case Manager Associate Resume Examples & Samples

  • (STD) Reviews and assesses claim details and contract provisions to determine whether or not to accept liability. Approves or denies benefits accordingly. Establishes future action plan
  • (LTD) Reviews existing claim file and system documentation. Establishes future action plan
  • Communicates with claimants and providers verbally and in writing and responds to inquiries
  • Makes appropriate claim payments
  • Consults with appropriate medical claim resources as needed
  • Updates files and accurately documents system and claim files on actions taken
  • Refers claims that exceed unit guidelines to more senior Case Managers
  • Maintains the established customer service, production, and quality standards
  • May be assigned to provide guidance and assistance to others
  • H.S. diploma plus 4 or more years of business experience with some exposure to insurance products
  • Demonstrated decision making, communication, and computer skills required
  • Strong ability to process multiple tasks quickly while providing excellent customer service
  • Knowledge of medical terminology and/or claim processing experience preferred
34

Short Term Disability Claims Manager Resume Examples & Samples

  • Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Pays all covered claims accurately and timely
  • Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
  • Ability to handle potentially high levels of call volume from customers and clients
  • Adheres to standard timeframes for processing mail, tasks and outliers
  • Ability to serve as a point person for projects and/or reporting functions
  • Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
  • Provides assistance to Senior Claim Manager with responsibilities as needed
  • Identifies issues, proposes solutions and follows through on commitments
  • Minimum of 3 years disability claim management experience
  • Exceptional customer service standards and delivery