Senior Disability Claims Analyst

Senior Disability Claims Analyst

Requirements

• Associates degree or equivalent work experience
• 3 to 5 years relevant experience in Disability Claims
• Understanding of medical terminology, disability duration guidelines and medical management practices.
• Basic understanding of personal and business tax returns.
• Critical thinking skills: gather information, apply reasoning, and make sound decisions based on analysis, experience, and judgment
• Ability to collaborate and work effectively on a team.
• Excellent communication skills both written and verbal.
• Demonstrated problem solving and negotiation skills.
• Understanding of contract law.
• Excellent organizational skills and the ability to effectively prioritize tasks.

Responsibilities

• Manage relationships by providing clients and advisors with clear understanding of requirements and status of claim.
• Manage claim documents as they are received.
• Communicate clearly and completely regarding the handling of the claim.
• Adjudicate timely claim payments by determining the type and amount of the claim, verify status of the insurance policy and riders, confirm policy provisions.
• Request and analyze medical, financial and occupational claim requirements; coordinate investigative efforts ensuring appropriate referral of claims to internal resources and outside vendors.
• Provide thorough review of contestable claims.
• Thoroughly and accurately document the claim file with subjective, objective, analysis and plan information.
• Understand and comply with Fair Claim Handling requirements, state regulatory requirements, insurance law and legal/compliance procedures related to contracts and insurance claims in general.
• Identify claim risk and red flags, mitigating such risk during adjudication of the claim.
• Utilize referral resources and vendors appropriately to manage risk and claim costs throughout the life of the claim.
• Perform secondary review and approval of peer claims within authorization level.
• Handle claim referrals from team members and assist with complex claims as necessary.
• Provide peer feedback and input to manager.
• Provide input to improve processes and procedures; participate in improvement initiatives.

Preferred Qualifications

No preferred qualifications provided.