Benefit Claim Specialist

Description:

WHAT YOU'LL DO:

• Make decisions in partnership with management based on a comprehensive understanding of claim facts and thorough evaluation of relevant information.
• Develop case files that showcase sound decision-making in accordance with documented procedures, using claim facts, policy provisions, and special handling agreements. Foster effective business relationships through clear communication with claimants, brokers, sales organizations, vendor partners, employers, and internal departments such as underwriting and legal.
• Thoroughly document all claim decisions and actions meticulously, maintaining regular and appropriate communication. 50% of your day will be on the phone with claimants, employers, and medical professionals throughout the entire claims life cycle.
• Review and determine ongoing claim liability, involving the evaluation of claim documentation, resolution of queries, and identification of any changes in claim status or benefits. Collaborate with internal and external partners, including brokers, sales organizations, clinical and physician resources, vocational experts, and financial resources.
• Accurately determine financial liability by analyzing salary, other income sources, medical/vocational information, and contract language. Exercise limited autonomy to approve initial and ongoing payments based on a holistic file evaluation.

WHAT YOU’LL BRING:

• 2 + Years of Long Term Disability Claims Experience.
• Demonstrate a foundational ability to analyze, comprehend and apply insurance provisions and contracts to disability claims.
• Ability to calculate disability benefits based on contract provisions and offset management to provide fair, equitable and consistent treatment of claims necessary for accurate financial payments and policyholder retention and satisfaction.
• Proficient with navigating multiple systems and Microsoft Office Suite
• Provide a solid level of customer service (written and verbal) while displaying empathy to customers.
• You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
• Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico