NEWPosted 6 hours ago

Job ID: JOB_ID_7825

Role Descriptions:

  • To provide disability case management and claim adjudications based on medical documentation and the applicable disability plan interpretation, including determining benefits due and making timely payments and adjustments.
  • Review and analyze medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
  • Able to make required outreaches for missing claims documentations to employee, physicians, or employers.
  • Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).
  • Partner with clinical and vocational resources to evaluate disability and support return to work goals.
  • Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a short term disability plan.
  • Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
  • Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
  • Determines benefits due, makes timely claims payments and/or approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
  • Refers cases as appropriate to team lead and clinical case management.
  • Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
  • Provide ideas to management on continuous improvement and service level management.
  • Performs other duties or participates in special projects as assigned.

Essential Skills:

  • Short Term Disability Case Associate

Desirable Skills:

  • None specified

Compensation & Location

Salary: $30 – $45 per year (Estimated)

Location: Remote

Recruiter / Company – Contact Information

Recruiter / Employer: KK Associates

Email: ali.s@kksoftwareassociates.com

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