Description: Disability Claims Specialist (Part Time)
MAX PAY RATE - *** per hour
Fully Remote
20 hours per week (Must be able to work during normal business hours)
Must have at least 3 years prior LTD/IDI Insurance Claims Experience

At ***, we seek to make a meaningful impact in the lives of our customers and our communities. The LTD Claim Consultant evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the LTD Claims Consultant is required to exercise independent judgment, critical thinking skills, exemplary customer service skills as well as effective inventory management skills.

Essential Business Experience and Technical Skills:
Required:

**3 years of LTD/IDI Insurance Claims experience
Prior experience with independent judgement and decision making while relying on the available facts
Be able to demonstrate the use of critical thinking and analysis when reviewing the information
Creative problem-solving abilities and the ability to think outside the box
Excellent interpersonal and communication skills in both verbal and written form
Excellent customer service skills proven through internal and external customer interactions
Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
Organizational and time management skills
Bachelor s degree

Key Responsibilities:
Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators
Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations
Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills
Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations
Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available
Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.
Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
Proficiently calculates monthly benefits due after elimination period, to include Client, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments
Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination.
Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.

Custom Fields:
Name: GL Account
Value: ***

Name: Onshore/Offshore
Value: Onshore

Name: Business Unit
Value: 01300

Name: On Site/Off Site
Value: Virtual - Working full-time in non-*** location

Name: Operating Unit
Value: 09000000

Name: ***LaptopDropdown
Value: Yes

Name: State
Value: None

Name: Country
Value: UNITED STATES

Name: City
Value: None

Name: Building Access Dropdown
Value: No

Name: Product Number
Value: 001000

Name: *** Systems Etc Dropdown
Value: Yes