Information Technology_USA - USA_Project Manager

Short Term Disability Case ManagerLocation: Cincinnati, OH / Hybrid / RemoteDuration: 6 monthsAct as a subject matter expert for short term disability claimsInterpret disability plans and insurance policies for claim decisionsServe as a liaison between claimants, employers, and clinical teamsEnsure compliance with disability regulations and company guidelinesSupport return-to-work and vocational rehabilitation initiativesProvide guidance on eligibility and benefits structureHandle escalations and complex case scenariosCollaborate with clinical and vocational resources for case evaluationDrive process improvements in claims operationsMaintain high standards of customer service and communicationManage disability case management and claim adjudication based on medical documentationReview and analyze medical records including diagnostic tests, office notes, and operative reportsDetermine claimant eligibility as per disability plan definitionsConduct outreach to employees, physicians, and employers for missing documentationUtilize clinical guidelines and in-house clinicians for case assessmentsPartner with clinical and vocational teams to evaluate disability and return-to-work plansApprove, deny, and authorize claims under short term disability policiesDetermine benefits due and process timely payments and adjustmentsCommunicate claim status and expectations via phone and written correspondenceManage workload, client deliverables, and second-level escalationsProcess claims involving Workers Compensation and disability offsetsRefer complex cases to team leads or clinical case managementPerform peer reviews to ensure accuracy and timelinessExperience in short term disability or disability claims managementStrong knowledge of disability plans and insurance processesAbility to interpret and review medical documentationKnowledge of Workers Compensation and disability offsetsStrong analytical and decision-making skillsExperience in claims adjudication and benefit determinationExcellent verbal and written communication skillsAbility to manage high-volume workloadsAttention to detail and accuracyFamiliarity with clinical guidelines and case evaluationDisability Claims ManagementCase AdjudicationMedical Records ReviewBenefits DeterminationRegulatory ComplianceCustomer CommunicationCase ManagementProcess ImprovementWorkload ManagementQuality Assurance4-6 years or above