What are the responsibilities and job description for the Disability Claims Specialist (Part-Time) position at Tailored Management?
Job Title : Disability Claims Specialist (Part-Time)
Pay Rate : $42.00 / hr
Location : Fully Remote (must be available during EST business hours)
Hours : 10-20 hours per week
Position Summary :
We strive to create meaningful impacts for our customers and communities. As a Disability Claims Specialist, you will evaluate long-term disability (LTD) insurance claims in alignment with policy provisions and service standards. This role requires independent judgment, critical thinking, excellent customer service, and inventory management skills.
Key Responsibilities :
- Effectively manage an assigned caseload of moderately complex claims, including pending, ongoing / active, and appeal reviews, with some level of oversight.
- Provide timely, balanced, and accurate claims reviews, documentation, and recommended decisions in a fast-paced environment, ensuring compliance with state and insurance regulations.
- Frequently communicate proactively with claimants and / or their representatives, demonstrating empathy, active listening, and providing clear updates, direction, and explanations regarding the claim process and benefits.
- Conduct calls to gather essential details about medical conditions, treatment, occupational demands, financial information, and other pertinent details, and document conversations professionally and promptly in the claim file.
- Interact and communicate effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations.
- Compile comprehensive file documentation and correspondence, analyzing information to identify additional data required for making reasonable and logical claim determinations.
- Collaborate with external and internal resources, including physicians, attorneys, and clinical / vocational consultants, to gather necessary medical and occupational information for thorough decision-making.
- Clarify and reconcile inconsistencies during claim evaluations, collaborating with Fraud Waste and Abuse resources when necessary.
- ccurately calculate monthly benefits, including offsets such as Social Security and Rehab Return to Work benefits, and manage other non-routine payments.
- Provide timely, detailed written communication throughout the claim evaluation process, outlining the status and determination of claims.
- ddress and resolve escalated customer complaints thoroughly and promptly, referring appropriate matters to appeals, complaints, or litigation support areas.
Qualifications :
Salary : $42
