Information Technology_USA - USA_Analyst

Short Term Disability Case Associate

Manage end-to-end disability case management and claims adjudication.

Review medical documentation to determine claim eligibility.

Interpret disability plans and policy guidelines accurately.

Coordinate with claimants, employers, and healthcare providers.

Ensure timely communication and resolution of claims.

Utilize clinical resources and duration guidelines for case evaluation.

Support return-to-work initiatives with vocational teams.

Handle workload management and prioritize claims efficiently.

Manage first-level and second-level escalations.

Ensure compliance with regulatory and company standards.

Participate in continuous improvement and service initiatives.

Maintain high standards of customer service and responsiveness.

Evaluate short-term disability claims based on medical evidence.

Review diagnostic reports, physician notes, and medical records.

Determine eligibility and calculate benefits as per plan terms.

Process claims approvals, payments, and adjustments.

Follow up for missing documents from employees, physicians, or employers.

Communicate claim decisions via calls and written correspondence.

Conduct claim investigations and validate data accuracy.

Manage daily workload and ensure timely claim processing.

Collaborate with clinical and vocational teams for decision-making.

Handle escalations and resolve issues within defined timelines.

Maintain audit-ready documentation and compliance records.

Suggest process improvements to enhance service quality.

Strong experience in disability claims processing.

Knowledge of short-term disability case management.

Ability to interpret medical documents and terminology.

Understanding of insurance policies and adjudication processes.

Strong analytical and decision-making skills.

Excellent verbal and written communication skills.

Ability to manage confidential and sensitive information.

Strong organizational and time management skills.

Experience in customer service and stakeholder interaction.

Familiarity with claims processing systems.

Attention to detail and high accuracy.

Ability to work under pressure and meet deadlines.

Disability claims adjudication.

Medical records analysis and interpretation.

Insurance policy evaluation.

Claims payment processing and adjustments.

Stakeholder communication and coordination.

Case management and prioritization.

Escalation handling and resolution.

Compliance and regulatory adherence.

Customer service and client handling.

Documentation and reporting.

Risk assessment and decision making.

Continuous process improvement.

4-6 years or above.