Case Manager I LTD
Core
Manage a caseload of long term disability claims, deciding on acceptance, denial, and payment duration based on contractual provisions and medical/occupational records.
Role type
Claims adjudication specialist
Builds
Long term disability benefit payments and claim decisions
Domain
Insurance / Disability benefits
Required skills
Analytical skills, critical thinking, negotiation, detailed claimant interviewing, written rationale preparation, vocational rehabilitation assessment, legal guideline application
Preferred skills
Court testimony experience, deposition experience, creative problem solving
Technologies
Claim paying systems
Responsibilities
Manage and prioritize a group of claims on an ongoing basis while maintaining appropriate documentation, Obtain all pertinent and necessary information to evaluate claim credibility, Prepare written rationale of claim decision based on review of contractual provisions and analysis of medical and occupational records, Process claims for payment by setting up on claim paying system to ensure accurate and timely receipt of payment benefits, Assess vocational rehabilitation opportunities by working with vocational staff, Use investigative tools, may testify in court cases and provide depositions related to claim disputes based on technical expertise