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Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in disability case management, including complex claim determinations and medical documentation analysis. Proficient in ERISA regulations, FMLA compliance, and effective communication with claimants and healthcare providers.
Highest-signal resume keywords
Disability Case ManagementERISA Regulations KnowledgeAnalytical And Critical Thinking SkillsEffective Decision-MakingStrong Organizational Skills
About the role
Key responsibilities & impact- Provides disability case management and complex claim determinations based on medical documentation and applicable disability plan interpretation
- Determines benefits due and makes timely payments, approvals, and adjustments
- Medically manages disability claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines
- Makes independent determinations to approve complex disability claims or recommends denial to the team lead
- Reviews and analyzes medical information to determine whether claimants are disabled under the disability plan
- Utilizes clinical resources in case assessment
- Determines benefits and offsets for workers compensation, SSDI, and other disability offsets
- Informs claimants about required documentation, deadlines, payment information, and claim status
- Communicates with claimants' providers regarding return-to-work expectations
- Communicates with claimants and clients throughout the claims process
- Coordinates investigations and reviews contested claims
- Arranges referrals to outside vendors or physician advisor reviews, surveillance, independent medical evaluations, functional capability evaluations, and related disability activities
- Negotiates return to work with or without accommodations through the claimant's physician and employer
- Refers cases to team lead and clinical case management for additional review
- Maintains professional client relationships and provides customer service
- Meets organizational quality program requirements
- Performs other duties as assigned
Requirements
What you’ll need- High School diploma or GED required
- Bachelor's degree from an accredited university or college preferred
- State certification or licensing in statutory leaves is preferred or may be required based on state regulations
- Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
- Knowledge of state and federal FMLA regulations
- Working knowledge of medical terminology and duration management
- Excellent oral and written communication, including presentation skills
- Proficient computer skills including working knowledge of Microsoft Office
- Analytical, interpretive, and critical thinking skills
- Ability to manage ambiguity
- Strong organizational and multitasking skills
- Ability to work in a team environment
- Ability to meet or exceed performance competencies as required by program
- Effective decision-making and negotiation skills
- Ability to exercise judgement autonomously within established procedures
- Ability to sit at a desk for extended periods while operating a computer and phone system
- Travel as required
Benefits
Comp & perks- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) and matching
- PTO
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending account or health savings account
- Other additional voluntary benefits
- Work-life balance
- Reasonable accommodations
- Equal opportunity workplace
- Drug-free workplace
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Documentation AnalysisBenefits DeterminationClaims ManagementKnowledge Of Medical TerminologySocial Security Application ProceduresDisability Duration ManagementStatutory Leaves CertificationMicrosoft Office ProficiencyNegotiation SkillsMultitasking
Soft Skills
Excellent Oral And Written CommunicationAbility To Manage AmbiguityTeam CollaborationCustomer Service OrientationPresentation Skills
Certifications & Qualifications
State Certification In Statutory Leaves
Industry Keywords
FMLA RegulationsDisability ClaimsComorbidities ManagementReturn-To-Work NegotiationIndependent Medical Evaluations