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    LTD Claims Specialist - New York, United States - Metasys Technologies

    Metasys Technologies
    Metasys Technologies New York, United States

    3 weeks ago

    Metasys Technologies background
    Description
    Long Term Disability Claims Specialist
    Fully Remote
    10-20 hours per week
    Must have at least 3+ years prior LTD/IDI Insurance Claims Experience


    Required:
    3+ years of LTD/IDI Insurance Claims experience
    Prior experience with independent judgement and decision making while relying on the available facts
    Be able to demonstrate the use of critical thinking and analysis when reviewing the information
    Creative problem-solving abilities and the ability to think outside the box
    Excellent interpersonal and communication skills in both verbal and written form
    Excellent customer service skills proven through internal and external customer interactions
    Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively
    Organizational and time management skills
    Bachelor's degree


    Key Responsibilities:


    Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews.

    The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators
    Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations

    Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions.

    These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim.

    Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills
    Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations
    Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available

    Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions.

    Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
    Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments

    Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination.

    Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.

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