Adjudication, Analysis Skills, Case Management, Claims Processing, Communication Skills, Consulting, Continuous Improvement, Documentation, Mail Processing, Medical Records, Team Lead/Manager, Time Management, Work From Home, Worker's Compensation
Role: Short Term Disability Case Associate
Location: Cincinnati OH/ Hybrid/ Remote
Duration: 6 moths
Required Skills: claim
Job Description:
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
For more information and other jobs available please contact our recruitment team at careers@tekfortune.com
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Tekfortune Inc.
Tekfortune is a software solutions company providing project development and staff augmentation services to companies in various industries including Healthcare, Banking, Finance, Telecommunication and Aviation.
Tekfortune Inc delivers solutions to a wide variety of organizations of various sizes and industries. Our clients include mid-market to Fortune 1000 companies spanning across industries such as: Insurance, Financial, Pharmaceutical, Manufacturing, Retail and many others.
In Tekfortune Inc, we are offering selection of services and solutions at very reasonable rates. With years of experience in the placement and recruitment Industry and over time we have acquired the knowledge essential to comprehend the exact need and dependence on customers. Therefore we provide the customers the best and also the brightest candidates for vacancies. Moreover, by understanding the working interest of customers who is able to place them within the companies where they are able to get maximum opportunity for professional growth.
Tekfortune Inc has a strong emphasis on quality. Its goal would be to achieve client satisfaction by looking into making deliveries satisfaction of customer's business needs. Our ability to quickly identify and effectively employ proven fundamental principles, techniques and resources yields highly desirable results for our clients.
We understand that each industry and organization share a level of uniqueness that requires a tailored approach in order to deliver specific solutions. Such factors as client culture, industry regulations, organizational maturity, financial health and many more items may impact our approach to delivering client solutions.
Having served a wide variety of clients has provided Tekfortune the ability to build subject matter expertise across numerous industries. Our industry expertise combined with our specialized knowledge of Business Process Improvement, Requirements Management and Program & Project Management provides a powerful combination and a tremendous value to our clients.
We are run by a group of industry experts who have decades of experience in delivering custom solutions to our clients.
20 to 49 employees
http://www.tekfortune.com/