Case Specialist

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Evaluate assigned claims and establish the benefits owed

• Notify claimants of the documentation necessary for claim processing and relevant timeframes

• Oversee claims to ensure adherence to plan provisions

• Provide necessary documentation to the LTD Manager for reporting purposes

• Assess the need for external vendors, surveillance, and/or independent medical evaluations

• Seek guidance from management as required

• Refer cases to the LTD Supervisor, LTD Manager, or Project Manager

• Negotiate settlements for applicable claims within the assigned authority limit

• Process claim payments and adjust benefit amounts as needed

• Update clients, claimants, and supervisors on the status of decisions

• Calculate and recover overpayments

• Perform additional tasks as assigned

• Contribute to the organization's quality initiatives

⛳️ Requirements

• Preferred: Bachelor's degree from an accredited institution

• Licenses as necessary

• A minimum of four (4) years in medical disability experience or an equivalent combination of education and experience is required

• Exceptional oral and written communication skills, including presentation abilities

• Proficient in PC applications, especially Microsoft Office

• Strong analytical and interpretive capabilities

• Excellent organizational skills

• Strong interpersonal abilities

• Highly developed negotiation skills

• Ability to collaborate effectively within a team

• Capability to meet or exceed Performance Competencies

• A credit security clearance, confirmed through a background credit check, is required

🏝️ Benefits

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) plan with matching contributions

• Paid time off (PTO)

• Disability insurance

• Life insurance

• Employee assistance programs

• Flexible spending or health savings accounts

• Additional voluntary benefits

• Reasonable accommodations provided when applicable and appropriate