Information Technology_USA - USA_Analyst

Short Term Disability Case Associate

Manage disability claims from initiation to closure

Review medical documentation to assess eligibility

Interpret disability plans and policy terms

Coordinate with claimants, employers, and healthcare providers

Ensure timely processing of claims and payments

Handle escalations and complex case scenarios

Collaborate with clinical and vocational teams

Maintain compliance with insurance and regulatory guidelines

Monitor workload and prioritize tasks effectively

Support return-to-work planning and outcomes

Provide disability case management and adjudicate claims based on medical evidence

Review diagnostic tests, medical records, and reports to determine disability status

Make outbound communications to collect missing documentation from employees, physicians, or employers

Use clinical guidelines and internal resources to assess case duration and validity

Partner with clinical and vocational experts for accurate claim evaluation

Approve, deny, or adjust claims as per short-term disability plan guidelines

Communicate claim decisions clearly through calls and written correspondence

Manage daily workload and handle first-level escalations efficiently

Review claims for accuracy, timeliness, and compliance standards

Process payments, adjustments, and offsets including Workers Compensation and State Disability

Refer complex cases to senior team members or clinical case management when needed

Contribute ideas for process improvements and service delivery enhancements

Strong knowledge of short-term disability claims processing

Ability to analyze medical records and documentation

Understanding of insurance policies and disability plans

Good communication skills (written and verbal)

Attention to detail and accuracy in claim adjudication

Ability to manage multiple cases simultaneously

Problem-solving and decision-making skills

Familiarity with claims systems and documentation workflows

Insurance and Disability Claims Management

Medical documentation analysis

Claim adjudication and benefit calculation

Stakeholder communication and coordination

Case management and escalation handling

Regulatory and compliance awareness

Time management and prioritization

Collaboration with clinical and vocational teams

Experience Required: 4-6 years or above