Disability Case Manager-Hybrid

Demonstrate independent problem solving and decision-making ability.
Able to clearly communicate claim decisions and contract language verbally and in written correspondence.
Demonstrate math aptitude, ability to multitask, and analytical skills.
Have 4-year college education or equivalent work/education experience.
Experience of 2 years of disability claim management experience (STD), or other previous Group insurance experience.
Have experience with candidate regulatory and compliance standards.

Using most efficient and effective means of proactive outreach to obtain and/or dispense information. Involving information to and from claimants, departmental managers, physicians, HR, Payroll, or any other sources.
Communicating claim status and decisions via telephone and in writing.
Initiating communications to claimant, physician, and /or plan holder to obtain information, make assessment, and initial claim decision.
Prioritizing and reviewing new claims to adhere to established departmental productivity. Meeting productivity requirements as established by department for handling “fast track” disability claims with limited durations.
Investigating and analyzing claim information to determine coverage and benefit eligibility. Performing pre-existing condition investigation and draft adverse determination letter, if applicable.
Determining disability by comparing functionality with job. Setting up claim for initial benefit approval including physician statement(s) and medical records.
Following claim management procedures and identifies potential return to work, job accommodation opportunities when applicable.
Utilizing claim management resources, i.e. MDA (Medical Disability Advisor), and other disability guidelines. Working with the goal of returning claimant to active work status.
Assessing claim when other sources of income are received to ensure accurate offsets are applied. Recalculating benefits as needed determining under/overpayments.

No preferred qualifications provided.