Information Technology_USA - USA_Project Manager

Pacer Group

Jacksonville, FL

Location: USA

Duration: 6 months

Role: Short Term Disability Case Manager

Manage end-to-end disability claims process from intake to closure
Act as primary point of contact for claimants, employers, and medical providers
Evaluate medical and non-medical information to support claim decisions
Ensure timely adjudication and payment of disability claims
Collaborate with clinical and vocational teams for case evaluation
Handle claim escalations and ensure resolution within timelines
Monitor workload and maintain productivity and accuracy standards
Support return-to-work initiatives for claimants
Maintain compliance with disability policies and regulatory guidelines
Contribute to process improvements and service quality enhancements

Responsibilities:

Review and analyze medical documents such as diagnostic tests, office notes, and operative reports
Determine claimant eligibility based on disability plan definitions
Perform outreach to employees, physicians, and employers for missing documentation
Utilize clinical resources and duration guidelines for case assessment
Partner with internal clinical and vocational teams for decision-making
Approve, authorize, and process disability claims and benefits
Calculate and manage payments, adjustments, and offsets (Workers Compensation, State Disability, etc.)
Communicate clearly with claimants and clients via calls and written correspondence
Manage workload, ensure timely processing, and handle escalations
Refer complex cases to team leads or clinical case management
Perform peer reviews to ensure accuracy and compliance

Essential Skills:

Strong experience in Short Term Disability case management
Ability to interpret medical records and disability plans
Knowledge of Workers Compensation and disability offsets
Strong analytical and decision-making skills
Excellent communication skills (written and verbal)
Ability to manage multiple claims in a fast-paced environment
Attention to detail and accuracy in claims processing

Core Skills:

Disability Claims Management
Medical Document Review and Analysis
Claims Adjudication and Benefit Calculation
Insurance Domain (Disability, Life & Annuity)
Case Management and Decision Making
Client and Stakeholder Communication
Regulatory Compliance and Policy Interpretation
Workload and Escalation Management
Process Improvement and Quality Assurance

Experience Required: 4- 6 years or above

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Vacancy posted 1 day ago

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