Disability Benefit Specialist

2 weeks ago

Peachtree Corners, GA, United States Crawford & Company Full time

The Disability Benefit Specialist will be relied upon to obtain and evaluate information in order to determine eligibility of benefits. Must be able to demonstrate a general knowledge of disability contracts, policies, and products and continued understanding of medical and vocational issues. Uses disability claims system for timely and accurate claims review, and effective communication of rationale for claims action. Communicates decisions effectively verbally and in writing to impacted parties such as Employees and Employers. Establishes future action plans and forms strategies for return to work based on the utilization of medical management resources, including the Client Advocate.

  • Bachelor's degree or equivalent experience required.
  • 2 + years of STD/LTD claims adjudication
  • Experienced in the TPA or self-administration services is desired
  • Experience with FMLA/State leave claims is a plus
  • Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
  • Ability to work independently while assimilating various technical resources
  • Computer knowledge in excel, word, web based systems, etc
  • Good verbal and written communication skills
  • Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
  • Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
  • Strong ability to identify, analyze and solve problems.
  • Effective interpersonal skills capable of dealing with external sources and all levels of employees.

#LI-DV1
  • Manages assigned caseload of disability claims for Short Term/Long Term Disability.
  • Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
  • Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
  • Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
  • Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
  • Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
  • Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards
  • Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.
  • Analyzes claims activity and prepares reports for clients/carriers and management as needed
  • Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.
  • Effectively works together in a team setting.
  • Other duties as assigned.

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