LTD Case Specialist

PRIMARY PURPOSE

To analyze claims and determine benefits due ensuring compliance with plan provisions; to determine need for outside vendors, surveillance, and/or independent medical evaluations; to negotiate settlements and to make claim payments and revisions within designated authority level; and to calculate and collect overpayments.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Analyzes assigned claims and determines benefits due.
• Informs claimants of documentation required to process their claim and timeframes.
• Manages claim to ensure compliance with plan provisions.
• Presents appropriate documentation to LTD Manager for reporting purposes.
• Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.
• Refers cases to LTD Supervisor, LTD Manager, or Project Manager.
• Negotiates settlement of appropriate claims within designated authority level.
• Makes claim payments and revisions to benefit amounts.
• Communicates status on decisions to client, claimant and supervisor.
• Calculates and collects overpayments.

ADDITIONAL FUNCTIONS AND RESPONSIBILITIES

• Supports the organization's quality program(s).

Qualifications

• Education & Licensing: Bachelor's degree from an accredited college or university preferred. Licenses as required.
• Experience: Four (4) years of medical disability experience or equivalent combination of education and experience required.
• Skills & Knowledge: Excellent oral and written communication, including presentation skills; PC literate, including Microsoft Office products; Analytical and interpretive skills; Strong organizational skills; Excellent interpersonal skills; Excellent negotiation skills; Ability to work in a team environment; Ability to meet or exceed Performance Competencies.

WORK ENVIRONMENT

• Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
• Physical: Computer keyboarding, travel as required.
• Auditory/Visual: Hearing, vision and talking.

Benefits

• A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.