Claims Analyst
- Siri Info INc
9 Days Ago
NA
W2, C2C
Cincinnati-OH
4-6 Years
Required Skills: Disability , Claims
Job Description
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 andor 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.
Essential Skills: Short Term Disability Case Associate
Desirable Skills:
Keyword:
Skills: Insurance - Disability Claims
Experience Required: 4-6
Keyword:
Skills: Insurance - Disability Claims
Experience Required: 4-6
