Insurance Claims Specialist (Disability Claims)

Job Title: Insurance Claims Specialist (Disability Claims)

Job Location: Cincinnati, OH/ Remote

Job Type: Contract

Job Duration: 12+ Months

Experience: 5+ Years

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 by phone and 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 Desirable Skills:

Email: [email protected]