Provides disability case management and complex claim determinations based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments/approvals and adjustments
Medically managing disability claims including comorbidities, concurrent plans, and complex ADA accommodations
Coordinates investigative efforts, thoroughly reviews contested claims, negotiates return to work with or without job accommodations, and evaluates and arranges appropriate referral of claims to outside vendors

High School diploma or GED required
Bachelor's degree from an accredited university or college preferred
State certification or licensing in statutory leaves is preferred or may be required based on state regulations
Three (3) years of benefits or disability case/claims management experience or equivalent combination of education and experience preferred
Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
Knowledge of state and federal FMLA regulations
Working knowledge of medical terminology and duration management
Excellent oral and written communication, including presentation skills
Proficient computer skills including working knowledge of Microsoft Office
Analytical, interpretive, and critical thinking skills
Ability to manage ambiguity
Strong organizational and multitasking skills
Ability to work in a team environment
Ability to meet or exceed performance competencies as required by program
Effective decision-making and negotiation skills
Ability to exercise judgement autonomously within established procedures

Senior Disability Representative

Key skills