Senior Disability Claims Examiner – LTD

Role Overview

• Responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims.
• Expected to utilize judgment and assess risk as you work with various business partners to render claim decisions.
• Partner with medical and vocational resources to evaluate disability and support return to work goals.
• Deliver an exceptional customer experience that serves to differentiate Prudential from our competitors and ensures that customer commitments and deliverables are achieved.
• Communication via telephone, email, and text with employees, employers, attorneys, and others.
• Review and interpret medical records, utilizing resources as appropriate.
• Complete financial calculations.
• Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered.
• Apply contract/policy provisions to ensure accurate eligibility and liability decisions.
• Demonstrate and apply analytical and critical thinking skills.
• Verify on-going liability and develop strategies for return-to-work opportunities as appropriate.
• Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication.
• Leverage a broad spectrum of resources, materials, and tools to render claims decisions.
• Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards.
• Work within a fast-paced environment, with tight deadlines and the ability to balance multiple priorities.
• Provide technical direction and/or mentorship to other claims personnel as needed.
• Work independently as well as within a team structure.

Requirements

• 4+ years of experience in Long Term Disability Claim Management required.
• Exceptional customer service skills.
• Ability to solve complex claim scenarios with minimal mentorship.
• Excellent claim/risk management skills and technical knowledge in contract interpretation and administration.
• Proven skills in positive and effective interaction with challenging customers.
• Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English).
• Excellent organizational and time management skills with ability to multitask and prioritize deadlines.
• Ability to manage multiple and changing priorities.
• Detail oriented; able to analyze and research contract information.
• Demonstrated ability to operate with a sense of urgency.
• Experience in effectively meeting/exceeding individual professional expectations and team goals.
• Demonstrated analytical and math skills.
• Ability to exercise critical thinking skills, risk management skills and sound judgment.
• Ability to adapt, problem solve quickly and communicate effective solutions.
• High level of flexibility to adapt to the changing needs of the organization.
• Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
• Continuous improvement mindset.
• A commitment to support a work environment that fosters Diversity and Inclusion.
• Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.

Benefits

• Market competitive base salaries, with a yearly bonus potential at every level.
• Medical, dental, vision, life insurance, disability insurance.
• Paid Time Off (PTO), and leave of absences, such as parental and military leave.
• 401(k) plan with company match (up to 4%).
• Company-funded pension plan.
• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.
• Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance.