Long Term Disability Claims Specialist

About Our Client

The organization operates within the healthcare industry, focusing on simplifying the healthcare experience and improving community health. It addresses challenges related to barriers in accessing quality care by creating a more responsive, affordable, and optimized health system. The organization impacts millions of lives and emphasizes equitable care that mitigates health disparities.

About the Opportunity

The Long-Term Disability Claims Specialist role is responsible for assessing eligibility and reviewing ongoing medical, vocational, and financial accuracy for Long Term Disability benefits. This position contributes to ensuring accurate claims adjudication and supports the overall integrity of the disability benefits process.

Responsibilities

• Provide deep operational expertise and general administrative support in reviewing, researching, investigating, negotiating, processing, and adjudicating complex Long-Term Disability (LTD) claims
• Communicate intricate claim statuses, formal liability decisions, and regulatory updates clearly, empathetically, and professionally in both written correspondence and verbal discussions
• Authorize appropriate monthly benefit payments and systematically refer complex claims to clinical subject matter experts or senior managers for validation of adverse determinations or over-limit financial approvals
• Analyze medical records, occupational data, and financial statements to evaluate ongoing disability eligibility and vocational capacity
• Manage a consistent caseload of active claims, ensuring timely reviews and strict adherence to internal service level agreements (SLAs) and state regulatory guidelines
• Document all investigative findings, claimant interactions, and contractual rationales thoroughly and accurately within the core claims management database

Requirements

• A High School Diploma, General Education Development (GED) certificate, or an equivalent structured combination of professional work experience
• A minimum of 18 years of age to meet compliance and processing prerequisites
• At least one (1) year of direct professional experience reviewing, investigating, and rendering initial liability determinations on Long-Term Disability (LTD) insurance claims
• At least one (1) year of active experience calculating, auditing, and issuing recurring monthly benefit payments on active Long-Term Disability portfolios
• Strong basic computer skills, including professional proficiency within Microsoft Word and Excel (such as basic formulas, formatting, and spreadsheet navigation)
• Absolute ability to work a full-time corporate schedule, Monday through Friday, during normal business hours, with flexibility for occasional overtime or weekend work as operational backlogs dictate
• Proven ability to handle highly confidential, sensitive medical documents discreetly and establish a secure, private, and distraction-free remote work area
• A permanent physical residence in an approved domestic location equipped with access to a secure, stable, high-speed wired internet connection

Pay Range and Compensation Package

Target annual base salary framework: $49,700.00 to $88,800.00 USD
Final salary placement within this broad tier is structured dynamically based on the final candidate's localized labor market rates, completed education, exact years of direct LTD adjudication experience, and industry-specific insurance certifications
Highly eligible to participate in structured performance incentive tracks, localized peer recognition programs, corporate equity stock purchase plans, and employer-matched retirement contributions upon meeting baseline vesting rules

Benefits & Perks

Structured 401(k) retirement savings plan featuring a competitive corporate matching contribution structure
Comprehensive health benefits overview—including standard medical, dental, and vision insurance options—to be detailed fully during the initial interview stages

Equal Opportunity Statement

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.