Manager, Claims

Overview

The Manager, Group Disability Claims oversees the review and management of disability claims, ensuring compliance with applicable company policy, contract language and State regulations. They lead a small team responsible for the entire claims lifecycle, including but not limited to evaluating medical records, coordinating with providers, and communicating with claimants to determine eligibility for benefits. The Manager will take the lead in resolving disputes, detecting fraud, and improving operational efficiency through strong analytical and communication skills.

Responsibilities

• Review medical records, policy guidelines, contract language, and financial information to assess claim validity and determine financial liability.
• Evaluate AEBA nurse recommendations including referrals for IMEs.
• Collaborate with healthcare providers, vocational experts, and other resources to gather necessary information (e.g., medical records to verify diagnoses and treatment plans) for a thorough and complete claim evaluation.
• Reach out to employers to verify Claimant’s  status, appropriate return to work if Claimant is not working, and if possible, whether light duty is available.
• Serve as a point of contact for the Claimant, providing prompt and accurate updates on claim status, explaining the claims process, and addressing related Claimant inquiries.
• Ensure claims are processed in accordance with relevant legal regulations and applicable company policies.
•  Identify  and carefully examine potential fraud within the claims process.
• Work to resolve issues and disputes that may arise during the claims process including, but not limited to, working with AEBA’s Appeals Department and relevant state regulatory agencies.
• Develop long term department strategies and policies and Implement best practices to enhance efficiency and effectiveness in claims processing.

Qualifications

• A bachelor’s degree in insurance, healthcare, or a related field and/or extensive work experience handling and processing disability claims.
• The ability to analyze complex information from various sources, including contract terms, conditions, limitations, and exclusions, is crucial for accurate decision-making.
• A demonstrated deep understanding of insurance policies, medical terminology, and relevant regulations (i.e., disability laws) is essential.
• Strong written and verbal communication skills, including empathetic listening and a high level of customer service, are vital for this role which interacts with Claimants and stakeholders.
• Meticulous attention to detail to ensure accuracy in claim assessment, determinations and documentation
• Compassionate customer service when working with Claimants navigating challenging personal circumstances.
• Familiarity with the software and systems used for disability claims processing.
• 4+ years of progressive experience in absence/disability management, insurance claims or the health benefits industry  preferred.
• 2+ years experience managing others

Benefits from Amalgamated:

• Hybrid work environment: 4 days in White Plains, NY with 1 scheduled work from home day.
• Commuter benefits,  including free onsite parking and shuttle service from White Plains Train Station.
• Training, growth and development opportunities.
• Generous vacation, paid time off and holidays.
• Subsidized company-sponsored Medical, Dental, and Vision insurance.