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Disability Representative

Location : Dublin, OH
Job Type : Temp/Contract
Hours : Full Time
Travel : No
Relocation : No

Job Description :

To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level.


 


RESPONSIBILITIES:



  • Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.

  • Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.

  • Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.

  • Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.

  • Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.

  • Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.

  • Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.

  • Refers cases as appropriate to supervisor and management.

  • Negotiates settlement of claims up to designated authority level.

  • Maintains professional client relationships


 


 


Required Qualifications :


  • Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures

  • LICENSING: At least one of the following licenses is required: RN, LVN, CRC, COHN, CVE, LPC or LCSW.

  • Three (3) years benefits or disability claims management experience required.

  • Excellent oral and written communication, including presentation skills

  • PC literate, including Microsoft Office products

  • Analytical and interpretive skills

  • Strong organizational skills

  • Ability to work in a team environment

  • Excellent negotiation skills

  • Ability to meet or exceed Performance Competencies

  • Baccalaureate degree from an accredited college or university in nursing, social work or vocational rehabilitation is preferred.


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