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Job Information
Job title

Disability Claims II

Company Corporate Resource Group of Mid America
Wage between $0.00 - $0.00 Annually
Location United States, Minnesota, Hopkins
Employment type Full Time
Education Not Specified
Year Experience 4 - 5 Years of Practical Experience
Travel Not Specified
Published on 8/13/2009
Description
To analyze reported claims
This position is to fill in for someone that is out so it could be as short as 2 weeks or open ended. Complete Description:
PRIMARY PURPOSE: To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

1. Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.

2. Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

3. Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.

4. Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.

5. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.

6. Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.

7. Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.

8. Refers cases as appropriate to supervisor and management.

9. Negotiates settlement of claims up to designated authority level.

10. Maintains professional client relationships.

11. Maintains a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.

QUALIFICATIONS:

Education & Licensing:
Baccalaureate degree from an accredited college or university in nursing, social work or vocational rehabilitation is preferred.

Skills & Knowledge:

Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Ability to work in a team environment
Excellent negotiation skills
High school diploma or GED required Required
Baccalaureate degree in nursing, social work or vocational rehabilitation Highly desired
Recent benefits and/or disability claims management Required
3 Years Experience in substance abuse claims Required
2 Years Experience in mental health claims Required
2 Years Basic Microsoft Office skills Required
Excellent Communication Skills Requireddf-tc

Experience/Skills
See Above
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