Long Term Disability Examiner
Full Time Remote
Excellent Benefits + Progression
The LTD Claim Examiner will manage an assigned caseload of Long Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners in order to gather the information that is most relevant to each claim. It also requires potentially complex benefit calculations on a monthly basis. The candidate will also evaluate customer eligibility and interact with internal and external customers including, but not limited to, customers, employers, physicians, internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim.
As a Long-Term Disability Claims Examiner, you will:
- Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block.
- Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint
- Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
- Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact
- Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Execute on all client performance guarantees
- Respond to all communications within customer service protocols in a clear, concise and timely manner
- Make fair, accurate, timely, and quality claim decisions
- Adhere to standard timeframes for processing mail, tasks and outliers
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated
- Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Clearly articulate claim decisions both verbally and in written communications
- Understand Corporate Compliance, Policies and Procedures and best practices
- Stay abreast of ongoing trainings associated with role and business unit objectives