To contribute to the overall success of Custom Disability Solutions objectives by providing timely and accurate support the RSL Direct team. To o btain and analyze information in order to make claim decisions and payments on disability claims. To develop and apply appropriate claim and disability management techniques to ensure prompt and accurate payment and liability management of disability claims. To provide responsive customer service to claimants, policyholders, brokers, and internal departments.
· Successful completion of the Employee Development Disability Policy Knowledge and Claim Adjudication course.
· Promptly and thoroughly investigates claims within departmental and regulatory guidelines.
· Interprets and administers contract provisions including, but not limited to, eligibility, covered monthly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations.
· Develops, implements and modifies disability management plan to establish strategy and manage outcome.
· Documents claim file actions and telephone conversations appropriately.
· Participates in departmental Focus Reviews.
· Identifies and investigates change in Total Disability definition (any occ).
· Refers claim activity outside authority level to Supervisor/Manager for review.
· Pro-actively communicates with claimants, policyholders, and physicians to resolve investigations issues.
· Establishes, communicates and manages claimant and policyholder expectations.
· Utilizes most efficient means to obtain claim information.
· Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations.
· Responds to customer service issues within required timeframes to meet customer expectations.
· Involves technical resources (Social Security Specialist, medical resources, vocational resources) at appropriate claim junctures.
· Supports relationships with technical resources to achieve optimal financial outcomes.
· Actively contributes to departmental service, quality and financial objectives.
· Remains current with all corporate and disability management practices.
· Collaborates with team members and management in identifying and implementing improvement opportunities.
· All other duties as assigned by management.
- BA/BS or equivalent combination of education and experience.
- 1 to 2 years of experience with LTD disability claims.
- Experience with computer applications – Word, Excel desired.
- Work experience in decision-making and information analysis.
- Ability to meet deadlines while balancing competing demands.
- Good math and calculation skills.
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