Disability Representative Sr

Disability Representative Sr

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

Responsibilities

• 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

Preferred Qualifications

• Bachelor’s degree from an accredited university or college preferred