Short Term Disability Claims Case Manager I

The STD Claims Case Manager I (CM) is responsible for administering and medically managing Group Short Term Disability claims with specific diagnoses that tend to resolve quickly. The CM will manage the claim according to the plan provisions, state and federal guidelines, and established protocols.  The CM must demonstrate the knowledge to work independently, interpret contract provisions, and utilize critical thinking skills for medical management to administer benefits through the appropriate claim duration or return to work. The CM is responsible for meeting key service deliverables such as turnaround times, quality assurance, and overall customer experience. 

This position utilizes problem solving and analytical, written, and verbal communication skills to ensure timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers.  This position will review claims for Short Term Disability and requires consistent and effective claim management skills to succeed in a collaborative, team-oriented culture with a goal to drive positive claim outcomes. 

Candidate Responsibilities

• Effectively understand contract language and plan design for group disability
• Communicate claim status and decisions via telephone and in writing 
• Initiate communications to claimant, physician, and planholder to assess and facilitate job accommodation opportunities
• Proactive outreaches to claimants, planholders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. current earnings, other income benefits, medical information, etc.); notifies claimants when claims are pended for missing information
• Proactively develop and execute an appropriate plan of action for pending and ongoing disability claims assigned by utilizing, managing and directing appropriate resources. Conduct timely and accurate benefit determination in accordance with policy provisions and regulatory and internal standards while providing sound customer service to all internal and external customers
• Investigate and analyze claim information in conjunction with contract provisions to determine coverage and benefit eligibility
• Recognize and adapt to fast-paced environment
• Determine if claimants meet the definition of disability as defined in the contact by reviewing occupational level and analyzing medical information
• Establish, document and execute claim action plan and recommended path including return to active work at claimant’s own job
• Determine Insured Earnings by reviewing payroll information from the planholder; then, calculate payable benefits according to plan provisions
• Follow all claim management procedures and facilitate potential return to work and job accommodation opportunities when applicable
• Utilize claim management resources such as MDA (Medical Disability Guidelines) and other disability tools to assist with appropriate durational disability
• Assess claim …