Complex Claims Manager, Long Term Disability Claims - Remote - United States

Complex Claims Manager, LTD Claims

The Complex Claims Manager, LTD Claims is responsible for making accurate decisions on assigned complex claims according to the plan provisions, state and federal guidelines, and established protocols. This position will manage a portfolio of claims which have complexities driven by things including but not limited to specialized contractual requirements, unique earnings, complex medical conditions, specialized occupational demands and/or the presence of potential fraud, waste and abuse indicators.

You are:

A highly motivated and reliable individual who is able to work with varying levels of supervision – independently and collaboratively. You are detail oriented and a decisive decision maker who is able to manage multiple complex priorities at the same time with a positive attitude.

You have:

• A minimum of 2 years of Group LTD claims experience
• Bachelor’s Degree (preferred) or equivalent professional experience
• A client focus with excellent verbal and written communication skills.
• Demonstrated ability to manage multiple tasks in accordance with regulatory requirements
• The ability to remain flexible due to changing business needs
• Excellent written and verbal communication skills
• Ability to exercise independent and sound judgement in decision making
• Ability to analyze evidence for discrepancies
• Ability to conduct research using multiple techniques
• Excellent time management and organizational skills
• Basic computer skills and knowledge, including Microsoft Office
• Understanding of basic medical terminology and medical conditions helpful

You will:

• Utilize strong claim management skills to plan, implement and execute the investigation of a case load of complex LTD claims
• Identify and interpret relevant plan language and thoroughly investigate all claim issues to make accurate and non-biased claim determination
• Evaluate complex medical, occupational, financial and other claim information in consultation with clinical, vocational or financial specialists …