Short Term Disability Case Associate

Request ID: 70708-1
Title: Short Term Disability Case Associate
Locations: Cary NC 27511
Duration: 6+ Months with Possible Extension.
Salary Range: $30- $35/Hour on W2 Only (All inclusive) Applicant must be willing to work on W2.

Job Overview
We are seeking a detail-oriented Short Term Disability Case Associate to manage disability case management and claims adjudication. This role will involve reviewing and analyzing medical information, interpreting disability plans, determining benefits, and ensuring timely payments and adjustments. The ideal candidate will be responsible for collaborating with clinical and vocational resources to assess disability, manage claims, and support the claimant's return-to-work goals.
Key Responsibilities:

• Disability Case Management : Provide case management for short-term disability claims, ensuring proper adjudication based on medical documentation and disability plan interpretation.
• Claims Adjudication : Review medical documentation (e.g., diagnostic tests, office notes, operative reports) to determine if the claimant is disabled as defined by the applicable disability plan.
• Claimant Outreach : Conduct outreach to claimants, physicians, and employers to obtain missing claim documentation and ensure proper claim processing.
• Clinical Resource Utilization : Utilize appropriate clinical resources, including in-house clinicians and duration guidelines, to assist in the case assessment and decision-making process.
• Collaboration for Return-to-Work Goals : Partner with clinical and vocational resources to evaluate disabilities and help establish return-to-work strategies.
• Claim Analysis and Authorization : Analyze, approve, and authorize assigned claims in accordance with the terms of short-term disability plans. Determine benefits due and ensure timely payments and adjustments are made.
• Client Communication : Communicate clearly and professionally with claimants and clients to set expectations for the entire claims process, through both phone and written correspondence.
• Critical Deliverables and Workload Management : Review and manage client critical deliverables. Oversee your own workload and manage second-level process escalations.
• Disability Offsets : Determine benefits due for various disability plans such as Workers' Compensation, State Short Term Disability, and other applicable disability offsets.
• Referrals and Escalations : Refer cases to team leads and clinical case management as appropriate.
• Process Review : Conduct peer reviews to ensure processes are accurate and completed in a timely manner. Provide feedback for continuous improvement and service level management.
• Special Projects : Participate in special projects or additional duties as assigned by management.

Essential Skills:

• Short Term Disability Claims : Experience in disability claims management, particularly short-term disability, with the ability to assess claims, approve, and determine benefits due.
• Medical Documentation Review : Ability to review medical information such as diagnostic tests , operative reports , and office notes to determine the claimant's eligibility.
• Claims Communication : Strong communication skills for effectively interacting with claimants, physicians, employers, and other stakeholders.
• Time Management : Ability to manage caseloads and prioritize tasks to meet deadlines and ensure timely claims processing.
• Problem Solving : Ability to handle first-level process escalations and resolve issues with claims or missing documentation.

Desirable Skills:

• Insurance - Disability Claims : Experience with insurance disability claims or working with disability benefits, specifically within short-term disability programs.
• Vocational and Clinical Collaboration : Experience collaborating with vocational and clinical resources for return-to-work assessments.
• Continuous Improvement : Ability to provide ideas and feedback on service level management and process improvements.

Experience Required:

• 4-6 years of experience in disability claims or a similar role, with a focus on short-term disability .
• Familiarity with disability benefits, medical documentation review, and claims processing.

Qualifications:

• Bachelor's Degree in a relevant field (preferred).
• Insurance Certifications or related qualifications are a plus.

Company Benefits & Culture

• Inclusive and diverse work environment
• Opportunities for professional growth and development
• Comprehensive health and wellness benefits

Appreciate your quick response and please feel free to reach me out for any query you may have.

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