Disability Case Manager

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Managing and administering assigned Group Short Term Disability claims.

• Adhering to plan provisions, as well as state and federal regulations, and established protocols.

• Employing the most effective and efficient methods of proactive outreach to gather and/or share information.

• Engaging with claimants, departmental managers, physicians, HR, Payroll, and other relevant sources for information exchange.

• Communicating the status of claims and decisions through both phone and written correspondence.

• Initiating contact with claimants, physicians, and/or plan holders to collect information, perform assessments, and make initial claim decisions.

• Prioritizing and reviewing new claims to comply with established departmental productivity standards.

• Meeting department-established productivity requirements for managing fast track disability claims.

• Investigating and analyzing claim information to assess coverage and benefit eligibility.

• Conducting investigations related to pre-existing conditions and drafting adverse determination letters, if necessary.

• Evaluating disability by comparing functionality against job requirements.

• Setting up claims for initial benefit approval, which includes obtaining physician statements and medical records.

• Following claim management protocols and identifying potential return-to-work and job accommodation opportunities when applicable.

• Utilizing claim management resources effectively.

• Working towards the goal of returning claimants to active work status.

• Assessing claims when other income sources are received to ensure correct offsets are applied.

• Recalculating benefits as required to determine any under or overpayments.

⛳️ Requirements

• Proven ability to solve problems independently and make informed decisions.

• Capable of clearly articulating claim decisions and contract language both verbally and in writing.

• Strong mathematical aptitude, multitasking abilities, and analytical skills.

• Bachelor’s degree or equivalent work/education experience.

• A minimum of 2 years of experience in disability claim management (STD) or prior experience in Group insurance.

• Familiarity with regulatory and compliance standards related to candidates.

🏝️ Benefits

• Health, dental, and vision coverage starting on Day One.

• Wellbeing programs.

• Retirement plans with contribution matching.

• Generous time off.

• Parental leave.

• Opportunities for continuing education.

• Career growth opportunities.

• Flexible working arrangements.