The Long Term Disability (LTD) Benefit Specialist is responsible for the fair, ethical and timely management of LTD claims. They have overall responsibility for managing disability claims in an ethical manner, ensuring quality decisions, benefit calculations, and delivering a very high level of customer service. They have responsibility to facilitate the timely transfer of integrated STD claims to LTD, without interruption or delay to a timely LTD decision. They are expected to deliver a very high level of customer service to claimants, customers, internal and external business partners.
· Responsible for the investigation, evaluation, interpretation and payment/denial of STD/LTD disability claims with sound and impartial judgment. Operates independently using appropriate duration guidelines when necessary.
· Ability to ensure and facilitate effectively transition of a STD claim to LTD.
· Must be able to interpret contract provisions, vocational and medical information independently.
· Must be able to problem solve independently.
· Can effectively explain complex claim situations.
· Must be able to interpret contract provisions and medical records independently.
· Must be decisive and action oriented with claims direction.
· Possesses effective communication skills to interact with claimants, policyholders, attorneys, physicians and brokers directly either orally or written.
· Responsible for internal and external customer satisfaction in the resolution of claim-specific issues.
· Conducts negotiations in identifying potential settlements.
· Actively leads and participates in identifying trends and in the development of new claim management strategies for LINKS.
· Provides mentoring in technical skills to STD Benefit Specialists.
· May act as a resource to our Legal department as it relates to compliance, legislative, legal and regulatory issues.
· Demonstrates positive leadership ability and a high level of self-leadership.
· Actively leads by example and by coaching, giving feedback, mentoring and improving quality of LTD claim practices.
· Ability to work on complex projects at the discretion of the Supervisor, Disability Claims.
· College degree or equivalent work experience is required.
· One to two years of disability claims experience is preferred, or demonstrated proficiency in current job.
· Able to read and correctly interpret a Long Term Disability contract is mandatory.
· Strong knowledge of IBM software programs including but not limited to:
Word-processing Software
Spreadsheet Software
E-Mail
· Medical terminology is necessary.
· Completion of Group AHIP, LOMA, ICA and other industry courses are desirable.
· Strong math skills are mandatory.
· Able to use logic, accuracy and strict attention to detail is mandatory.
· Excellent analytical, problem solving and communication skills are required.
Regular and predictable attendance is required