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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing medical disability claims, ensuring compliance with plan provisions, and effectively communicating with clients and stakeholders. Proficient in negotiation and documentation management to support quality programs and performance competencies.
Highest-signal resume keywords
Medical Disability ExperienceClaims AnalysisNegotiation SkillsMicrosoft Office ProficiencyAnalytical Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims ManagementBenefit CalculationDocumentation PreparationCompliance ManagementOverpayment Calculation
Soft Skills
Excellent CommunicationStrong Organizational SkillsInterpersonal SkillsTeam CollaborationPresentation Skills
Certifications & Qualifications
Licenses as Required
Industry Keywords
Quality ProgramsPerformance CompetenciesCredit Security ClearanceIndependent Medical EvaluationsSurveillance
About the role
Key responsibilities & impact- Analyze assigned claims and determine benefits due
- Inform claimants of documentation required to process claims and applicable timeframes
- Manage claims to ensure compliance with plan provisions
- Provide appropriate documentation to the LTD Manager for reporting purposes
- Determine the need for outside vendors, surveillance, and/or independent medical evaluations
- Seek management advice as necessary
- Refer cases to the LTD Supervisor, LTD Manager, or Project Manager
- Negotiate settlements of appropriate claims within designated authority level
- Make claim payments and revisions to benefit amounts
- Communicate decision status to clients, claimants, and supervisors
- Calculate and collect overpayments
- Perform other duties as assigned
- Support the organization's quality programs
Requirements
What you’ll need- Bachelor's degree from an accredited college or university preferred
- Licenses as required
- Four (4) years of medical disability experience or equivalent combination of education and experience required
- Excellent oral and written communication, including presentation skills
- PC literacy, 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
- Credit security clearance, confirmed via a background credit check, is required
Benefits
Comp & perks- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) and matching
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Reasonable accommodations when applicable and appropriate