Disability Claims Case Manager
- Siriinfo
2 Hours Ago
NA
NA
Remote
8-21 Years
Required Skills: Disbility, case , claim
Job Description
Disability Claims Case Manager / Adjudicator
Cincinnati OH/ Hybrid/ Remote
6-12+ Months CTH
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.
