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Long Term Disability Claims Case Manager 1

Company: Guardian Life
Location: Bethlehem
Posted on: September 13, 2018

Job Description:

Position SummaryAre you a driven, service-oriented, self-starting individual looking for a new opportunity? If yes, read more to find out about who we are and the possibilities we can offer you.

The start of this class will begin on October 29, 2018, with 16 weeks of paid training. The hours of training and the work schedule will be 8:00 am to 4:30 pm, Monday through Friday. Time off during the training period is not permitted in an effort to successfully train all new hires. However, company holidays will be acknowledged.After successful completion of the training period, this position is responsible for achieving superior results by making appropriate decisions on assigned claims through proactive case management according to the plan provisions, state and federal guidelines, established protocols and quality standards. This position involves collaboration with mentors, other team members and our Professional Resources Team to assist claimants with return to work efforts, if, and when capability and opportunity exists.

Candidate Responsibilities

  • Proactively develop and execute an appropriate plan of action for pending and ongoing disability claims by utilizing, managing and directing appropriate resources. Conduct timely and appropriate benefit determinations in accordance with policy provisions and regulatory and internal standards while providing sound customer service to all internal and external customers.
  • Investigate and analyze claim information to determine coverage and benefit eligibility. Perform pre-existing condition investigation and draft adverse determination letter if applicable. Perform contestability investigation, evaluate for possible rescission, make rescission determination and draft rescission letter if applicable
  • Determine disability by comparing functionality with job description by reviewing medical information including physician statement(s) and medical records and utilize appropriate clinical resources as appropriate.
  • Proactively establish and execute an appropriate action plan and recommended path, including return to work own occupation, another occupation or Social Security Application
  • Calculate Insured Earnings by reviewing payroll records, tax returns (including W2s), partnership records and buy sell agreements and calculate payable benefits according to plan provisions within global payment authority of $0.00 while being mentored then $15,000.00 once released.
  • Track and record statistical data on DCMS (Disability Claim Management System) such as ICD codes, integration current monthly earnings offset, and benefit limitations for reserves, reports and future profitability
  • Prioritize and review new claims and correspondence to adhere to established turn-around times
  • Assess claim when other sources of income are received (e.g., social security, workers compensation, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits as needed determining under/overpayments. Proactively work with claimants to recover overpayments in full or negotiate monthly installments according to established protocols
  • Professionally and clearly communicate claim status and decisions via telephone and in writing
  • Provide proactive outreach to claimants, planholders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. tax returns, partnership records, current earnings, other income benefits and medical information etc.,)

    Reporting Relationships

    This position reports to an LTD Team Leader, who, in turn, reports to the Manager of LTD Claims.

    Functional Skills

    • Outstanding customer service skills
    • Excellent analytical skills
    • Strong math aptitude skills
    • Ability to prioritize caseloads to meet turnaround times
    • Demonstrate independent problem solving and decision-making ability
    • Ability to communicate claim decisions and corresponding contract language verbally and in writing
    • Ability to work independently and within a highly collaborative team environment

      Leadership Behaviors

      • Continuously strives to achieve superior results
      • Expresses oneself in a confident and trustworthy manner
      • Demonstrates a sense of urgency in a fast-paced work environment
      • Demonstrates the ability to adapt to change

        Keywords: Guardian Life, Bethlehem , Long Term Disability Claims Case Manager 1, Executive , Bethlehem, Pennsylvania

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