Disability Claims Analyst

Overview:

1.To provide disability case management and claim adjudications| based on medical documentation and the applicable disability plan interpretation| including determining benefits due and making timely payments and adjustments.

2.Review and analyze medical information (i.e. diagnostic tests| office notes| operative reports| etc.) to determine if the claimant is disabled as defined by the disability plan.

3.Able to make required outreaches for missing claims documentations to employee| physicians| or employers.

4.Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines| in-house clinicians).

5.Partner with clinical and vocational resources to evaluate disability and support return to work goals.

6.Analyzes| approves and authorizes assigned claims and determines benefits due pursuant to a short term disability plan.

7.Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone andor written correspondence.

8.Reviews client critical deliverables| manages the overall workload| and second-level process escalation.

9.Determines benefits due| makes timely claims payments and or approvals and adjustments for Workers Compensation| State Short Term Disability| and other disability offsets.

10.Refers cases as appropriate to team lead and clinical case management.

11.Responsible for managing the day-to-day workload and first-level process escalation| and reviews processes for accuracy and timeliness where applicable in case of peer reviews.

12.Provide ideas to management on continuous improvement and service level management.

13.Performs other duties or participates in special projects as assigned