LTD Claims Examiner II

About the position

The position involves obtaining and analyzing information to make claim decisions and payments on long-term disability (LTD), voluntary disability, and waiver of premium claims. The role aims to consistently render appropriate claim determinations based on a thorough review of all available information and the applicable policy terms. It requires reviewing and investigating disability claims through communication with various parties to gather pertinent data, adjudicating claims accurately and fairly, and managing a caseload of 60-80 claims independently.

Responsibilities
• Obtain and analyze information to make claim decisions and payments on LTD, voluntary disability, and waiver of premium claims.
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• Review and investigate disability claims using telephone and written contact with claimants, employers, and medical professionals.
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• Adjudicate claims accurately and fairly in accordance with the contract and relevant regulations.
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• Utilize medical and risk resources, adhering to referral policies, and transfer claims to the appropriate risk level.
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• Conduct in-depth investigations for pre-existing conditions or contestable claims.
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• Calculate benefit payments, including partial disability and survivor benefits.
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• Develop and maintain online claim data and paper files as applicable.
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• Provide respectful, prompt, concise, and accurate customer service in a high-demand environment.
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• Independently manage a caseload of simple to complex claims, ensuring productivity and quality standards are met.

Requirements
• High School Diploma or GED required; Associate's degree in Business, Finance, Social Work, or Human Resources preferred.
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• 2 years of experience processing long-term disability claims.
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• Demonstrated understanding of claim management techniques and critical thinking skills.
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• Experience working in confidential/protected identification environments.
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• Knowledge of medical terminology and good math skills.

Nice-to-haves
• Level I LOMA designation preferred.

Benefits
• Annual performance bonus for all team members.
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• Generous 401(k) company match that is immediately vested.
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• Choice of three medical plans including prescription drug coverage.
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• Company contribution to Health Savings Account for High Deductible Health Plan enrollees.
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• Multiple options for dental and vision coverage.
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• Company provided Life & Disability Insurance.
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• Paid Parental Leave & Adoption Assistance.
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• Hybrid work arrangements for eligible roles.
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• Tuition Reimbursement and Continuing Professional Education.
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• Paid Time Off, volunteer days, and Employee Assistance Program.

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