Disability Benefit Specialist

About the Role

Join a team that values compassion, clarity, and results as a Disability Benefit Specialist. In this role, you will evaluate claims, determine benefit eligibility, and guide employees toward successful return-to-work strategies. Use your expertise in disability policies and medical/vocational issues to deliver clear, timely decisions and exceptional support.

Responsibilities

• Manages assigned caseload of disability claims for Short Term/Long Term Disability.
• Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
• Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
• Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
• Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
• Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
• Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards.
• Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well-managed and seamless claims experience to claimants.
• Analyzes claims activity and prepares reports for clients/carriers and management as needed.
• Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients.
• Serves as a resource for trainees and Claims processors as needed.
• Effectively works together in a team setting.
• Other duties as assigned.

Qualifications

• Bachelor's degree or equivalent experience required.
• 2+ years of STD/LTD claims adjudication.
• Experience in the TPA or self-administration services is desired.
• Experience with FMLA/State leave claims is a plus.
• Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations.
• Ability to work independently while assimilating various technical resources.
• Computer knowledge in Excel, Word, web-based systems, etc.
• Good verbal and written communication skills.
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures.
• Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
• Strong ability to identify, analyze and solve problems.
• Effective interpersonal skills capable of dealing with external sources and all levels of employees.

Benefits

• Medical, Dental and Vision Plans.
• Prescription Drugs.
• HSA, HRA, and FSA Accounts.
• Paid Holidays, Vacation and Sick Leave.
• 401(k) Retirement Plan.
• Tuition Assistance.
• Paid Parental Leave.
• Supplemental Health Benefits.
• Enhanced Mental Health Support (no cost).
• Virtual Physical Therapy (no cost).
• Caregiving Services (no cost).
• Life Assistance Program (no cost).
• Training programs that promote continuous learning and career progression while enhancing job performance.
• Sustainability programs that give back to the communities in which we live and work.
• A culture of respect, collaboration, entrepreneurial spirit and inclusion.