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Posted: 10/20/2026Core Competencies
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 compliance with ERISA and FMLA regulations. Proficient in analyzing medical documentation and managing claims while maintaining effective communication with claimants and providers.
Highest-signal resume keywords
Disability Case ManagementERISA Regulations KnowledgeFMLA Regulations KnowledgeAnalytical SkillsEffective Communication
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
- Reviews and analyzes complex medical information to determine whether claimants are disabled under the disability plan
- Oversees complex claims involving comorbidities, concurrent plans, complex ADA accommodations, and claims outside typical guidelines
- Utilizes clinical resources in case assessment as needed
- Informs claimants of required documentation, time frames, payment information, and claim status
- Communicates with claimants’ providers regarding return-to-work expectations
- Medically manages complex disability claims in compliance with duration control guidelines and plan provisions
- Communicates with claimants and clients regarding all aspects of the claims process
- Coordinates investigative efforts and reviews contested claims
- Arranges referrals to outside vendors, physician advisors, surveillance, independent medical evaluations, and functional capability evaluations
- Negotiates return to work with or without accommodations through the claimant’s physician and employer
- Refers cases for additional team lead and clinical case management review when appropriate
- Maintains professional client relationships and provides customer service
- Meets organizational quality program requirements
- Performs other assigned duties
Requirements
What you’ll need- High School diploma or GED required
- State certification or licensing in statutory leaves 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 judgment 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
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending account or health savings account
- Additional voluntary benefits
- Reasonable accommodations
- Work-life balance
- Career growth opportunities
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 ManagementMedical TerminologyDuration ManagementCritical ThinkingDecision-Making
Soft Skills
Organizational SkillsMultitasking SkillsNegotiation SkillsTeam CollaborationCustomer Service
Tools & Technologies
Microsoft Office
Certifications & Qualifications
State Certification in Statutory Leaves
Industry Keywords
Disability Plan InterpretationComplex ClaimsComorbiditiesReturn-to-Work NegotiationIndependent Medical Evaluations