LTD, IDI, DISABILITY, CLAIMS, Insurance Claims, Claims Management, Case Management, Analysis Skills, Claims Processing, Communication Skills, Consulting, Customer Support/Service, Disability Insurance, Medical Records, Regulatory Requirements, Time Management,
Requirements:
- 3+ years of LTD/IDI Insurance Claims experience.
- Prior experience with independent judgement and decision making while relying on the available facts.
- Be able to demonstrate the use of critical thinking and analysis when reviewing the information.
- Creative problem-solving abilities and the ability to think outside the box.
- Excellent interpersonal and communication skills in both verbal and written form.
- Excellent customer service skills proven through internal and external customer interactions.
- Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively.
- Organizational and time management skills.
- Bachelor’s degree.
Key Responsibilities:
- Manage a caseload of moderately complex Long-Term Disability (LTD) claims, including new, ongoing, and appeal cases, while meeting productivity and quality standards.
- Evaluate claims and make accurate, timely decisions in accordance with policy provisions, regulatory requirements, and service-level expectations.
- Communicate with claimants, representatives, healthcare providers, attorneys, and other stakeholders to obtain and verify claim-related information.
- Review medical, vocational, financial, and occupational documentation to determine claim eligibility and identify additional information when needed.
- Maintain thorough, accurate claim documentation and prepare professional written correspondence regarding claim status and decisions.
- Collaborate with internal teams and external experts to support comprehensive claim evaluations.
- Resolve discrepancies, identify potential fraud concerns, and escalate issues when appropriate.
- Calculate disability benefits, including applicable offsets and return-to-work adjustments.
- Handle escalated customer inquiries and complaints with professionalism, ensuring timely resolution or referral to the appropriate team.
Scope:
The Long-Term Disability (LTD) Claims Consultant is responsible for evaluating and administering long-term disability insurance claims in accordance with policy provisions, regulatory requirements, and established service-level standards. This role requires strong analytical and decision-making abilities to assess claim eligibility, interpret medical and vocational information, and make accurate claim determinations. The consultant exercises independent judgment, demonstrates excellent customer service, communicates effectively with claimants and stakeholders, and manages a high-volume caseload while ensuring timely and compliant claim processing.