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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in analyzing and managing disability claims, ensuring compliance with ERISA regulations and effective communication with claimants and providers. Proficient in medical management practices and skilled in negotiation and organizational quality programs.
Highest-signal resume keywords
Disability Claims ManagementERISA Regulations KnowledgeMedical Terminology ProficiencyAnalytical SkillsNegotiation 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
Disability Claims AnalysisBenefits DeterminationMedical Management PracticesCase AssessmentDocumentation Review
Soft Skills
Excellent CommunicationStrong Organizational SkillsTeam CollaborationPresentation Skills
Tools & Technologies
Microsoft Office
Industry Keywords
Workers' CompensationSSDIDisability OffsetsDuration Control GuidelinesCredit Security Clearance
About the role
Key responsibilities & impact- Analyze, approve, and authorize assigned disability claims and determine benefits due under disability plans
- Review complex medical information to determine whether claimants are disabled under the applicable disability plan
- Use clinical resources in case assessment
- Communicate with claimants' providers regarding return-to-work expectations
- Determine benefits, payments, approvals, and adjustments for workers' compensation, SSDI, and other disability offsets
- Medically manage disability claims in compliance with duration control guidelines and plan provisions
- Communicate claims-process information with claimants and clients by phone and written correspondence
- Inform claimants about required documentation, time frames, payment information, and claim status
- Coordinate investigative efforts and review contested claims
- Arrange referrals to outside vendors or physician advisors for surveillance, independent medical evaluations, functional capability evaluations, and related disability activities
- Negotiate return to work with or without accommodations through claimants' physicians and employers
- Refer cases to team leads and clinical case management as appropriate
- Maintain professional client relationships
- Support organizational quality programs
- Perform other assigned duties
Requirements
What you’ll need- Bachelor's degree from an accredited university or college preferred
- Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience required
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices, and Social Security application procedures
- Working knowledge of medical terminology and duration management
- Excellent oral and written communication, including presentation skills
- PC literacy, including Microsoft Office products
- Analytical and interpretive skills
- Strong organizational skills
- Ability to work in a team environment
- Excellent negotiation skills
- 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
- PTO
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending account or health savings account
- Additional voluntary benefits
- Reasonable accommodations when applicable and appropriate