Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards; handles the most complex claims from a clinical and financial perspective; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible.
Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claims team operational metrics.
Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimant’s and employer’s trust and confidence; anticipates customer’s needs and takes action as appropriate.
Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence.
Mentors and coaches new team members and participates in projects supporting the team’s business initiatives.
Performs other related duties as required.
Requirements
Strong familiarity with disability claim management concepts
Strong understanding of medical terminology/pathology/anatomy
Articulate verbal and writing skills, decision making, meeting deadlines, working with confidential information
Strong skills with Microsoft Office and other software applications
Customer service skills
Stress tolerance
Math skills
Ability to multi-task and prioritize
High level of attention to detail
Can work under pressure
Confidence to make claim decisions
Results-driven
High attention to departmental/company procedures/practices
High School Diploma or equivalent
3 - 5 years of STD Industry claims management experience
Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services
Or an equivalent combination of education and experience