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Role: Short Term Disability Case Associate
Location: Cincinnati OH/ Hybrid/ Remote
Duration: 6 moths
Required Skills: claim
Job Description:
To provide disability case management and claim adjudications| based on medical documentation and the applicable disability plan interpretation| including determining benefits due and making timely payments and adjustments. - Review and analyze medical information (i.e. diagnostic tests| office notes| operative reports| etc.) to determine if the claimant is disabled as defined by the disability plan.- Able to make required outreaches for missing claims documentations to employee| physicians| or employers.- Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines| in-house clinicians).- Partner with clinical and vocational resources to evaluate disability and support return to work goals.- Analyzes| approves and authorizes assigned claims and determines benefits due pursuant to a short term disability plan.- Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone andor written correspondence.- Reviews client critical deliverables| manages the overall workload| and second-level process escalation.- Determines benefits due| makes timely claims payments and or approvals and adjustments for Workers Compensation| State Short Term Disability| and other disability offsets.- Refers cases as appropriate to team lead and clinical case management.- Responsible for managing the day-to-day workload and first-level process escalation| and reviews processes for accuracy and timeliness where applicable in case of peer reviews.- Provide ideas to management on continuous improvement and service level management.- Performs other duties or participates in special projects as assigned.
Essential Skills: Short Term Disability Case Associate
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