Disability Claims Specialist
Remote Position
12+ Months Project
Responsibilities: Manage an assigned caseload of moderately complex LTD claims, including pending, ongoing, active, and appeal reviews, with some level of oversight.
Provide timely, balanced, and accurate claims reviews, documentation, and recommended decisions in a fast-paced environment, in accordance with state and department of insurance regulations.
Communicate frequently and proactively with claimants and their representatives, demonstrating empathy and active listening, while providing updates, direction, and explanations regarding the claim process, benefits, and other plan provisions.
Document conversations within the claim file using appropriate detail and professional writing skills.
Interact and communicate effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations.
Compile file documentation and correspondence requiring extensive policy and factual detail; analyze information to determine if additional information is needed for a logical claims determination.
Collaborate with external and internal resources, such as physicians, attorneys, and clinical/vocational consultants, to gather necessary data for thorough decisions.
Clarify and reconcile inconsistencies during claim evaluations and collaborate with Fraud Waste and Abuse resources as needed.
Calculate monthly benefits due after the elimination period, including COLA, Social Security Offsets, Rehab Return to Work benefits, and other non-routine payments.
Provide timely and detailed written communication outlining the status of claim evaluations and determinations.
Address and resolve escalated customer complaints in a timely and thorough manner; refer appropriate matters to appeals, complaint, or litigation support areas.
Requirements: 3+ years of LTD/IDI insurance claims experience.
Prior experience with independent judgment and decision-making based on available facts.
Demonstrated use of critical thinking and analysis when reviewing information.
Creative problem-solving abilities and the ability to think outside the box.
Excellent interpersonal and communication skills, both verbal and written.
Proven customer service skills through internal and external interactions.
Demonstrated conceptual thinking, risk management, and ability to handle complex situations effectively.
Organizational and time management skills.
Bachelor's degree.
Metasys Technologies is an equal opportunity employer
All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
