Information Technology_USA - USA_Analyst

Short Term Disability Case Associate

Location: Cincinnati OH/ Hybrid/ Remote

Duration: 6 months

Job Responsibilities

• Manage disability claims and adjudication processes as per policy guidelines
• Analyze medical documentation to assess eligibility for disability benefits
• Collaborate with clinical and vocational teams for case evaluations
• Communicate with claimants, employers, and healthcare providers
• Ensure compliance with disability plans and regulatory requirements
• Handle client deliverables and manage workload efficiently
• Participate in continuous improvement initiatives within claims processes
• Support return-to-work programs through proper case handling
• Maintain high standards of accuracy and service quality
• Act as a point of contact for claims-related queries and escalation

Responsibilities

• Review and analyze medical records such as diagnostic tests, reports, and physician notes
• Determine disability status based on plan definitions and guidelines
• Calculate and authorize benefits including payments and adjustments
• Handle outreach for missing documentation from claimants, physicians, or employers
• Utilize clinical resources and duration guidelines for case assessments
• Manage short-term disability, workers’ compensation, and state disability claims
• Communicate claim decisions clearly via phone and written correspondence
• Handle first-level escalations and support second-level reviews when required
• Ensure timely processing of claims and adherence to SLAs
• Maintain proper documentation and audit readiness of claims handled
• Participate in peer reviews to ensure process accuracy and consistency
• Identify and recommend process improvements for better efficiency

Essential Skills

• Experience in short-term disability claims processing and adjudication
• Strong understanding of insurance and disability claim policies
• Ability to interpret medical documentation and reports
• Knowledge of workers’ compensation and state disability programs
• Strong analytical and decision-making skills
• Excellent written and verbal communication skills
• Ability to manage multiple cases and prioritize workload
• Attention to detail and accuracy in claims processing
• Familiarity with claim management systems and tools
• Strong customer service and stakeholder handling skills

Core Skills

• Disability claims management
• Insurance domain expertise
• Medical document analysis
• Claims adjudication and benefit calculation
• Stakeholder communication
• Process improvement and quality control
• SLA and workload management
• Escalation handling
• Documentation and compliance
• Customer service orientation

Experience Required: 4-6 years or above