Disability Benefit Specialist - CA
- Career Level
- Not Specified
The Disability Benefit Specialist will be relied upon to obtain and evaluate information in order to determine eligibility of benefits. Must be able to demonstrate a general knowledge of disability contracts, policies, and products and continued understanding of medical and vocational issues. Uses disability claims system for timely and accurate claims review, and effective communication of rationale for claims action. Communicates decisions effectively verbally and in writing to impacted parties such as Employees and Employers. Establishes future action plans and forms strategies for return to work based on the utilization of medical management resources, including the Client Advocate.
- Manages assigned caseload of disability claims for Short Term/Long Term Disability.
- Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
- Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
- Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
- Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
- Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
- Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards
- Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.
- Analyzes claims activity and prepares reports for clients/carriers and management as needed
- Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.
- Effectively works together in a team setting.
- Other duties as assigned.
Bachelors degree or equivalent experience required.
2 + years of STD/LTD claims adjudication.
Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
Ability to work independently while assimilating various technical resources
Computer knowledge in excel, word, web based systems, etc
Good verbal and written communication skills
Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
Strong ability to identify, analyze and solve problems.
Effective interpersonal skills capable of dealing with external sources and all levels of employees.
- Experienced in the TPA or self-administration services is desired
- Experience with FMLA/State leave claims is a plus
Broadspire (www.choosebroadspire.com), a leading international third party administrator, provides risk management solutions designed to help clients improve their financial results. Broadspire offers casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics. As a Crawford Company, Broadspire is based Atlanta, Ga., with 85 locations throughout the United States. Services are offered by Crawford & Company under the Broadspire brand in Europe (www.Broadspire.eu), including the United Kingdom (www.BroadspireTPA.co.uk).
In addition to a competitive salary, Crawford offers you:
- Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries;
- On-going training opportunities through every stage of your career
- Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V
Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.