Disability Benefit Specialist
Key Skills for This Role
Full Job Posting
Qualifications
- Bachelor's degree or equivalent experience required.
- 2 + years of STD/LTD claims adjudication
- Experienced in the TPA or self-administration services is desired
- Experience with FMLA/State leave claims is a plus
- Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
- Ability to work independently while assimilating various technical resources
- Computer knowledge in excel, word, web based systems, etc
- Good verbal and written communication skills
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
- Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
- Strong ability to identify, analyze and solve problems.
- Effective interpersonal skills capable of dealing with external sources and all levels of employees.
- #LI-DV1
Responsibilities
- Manages assigned caseload of disability claims for Short Term/Long Term Disability.
- Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
- Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
- Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
- Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
- Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
- Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards
- Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.
- Analyzes claims activity and prepares reports for clients/carriers and management as needed
- Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.
- Effectively works together in a team setting.
- Other duties as assigned.
Preferred Qualifications
- Experienced in the TPA or self-administration services is desired
- Experience with FMLA/State leave claims is a plus
About Crawford & Company
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