Disability Claims & Underwriting Specialist

This is a fully remote position, open to applicants in United States, +5 more countries.

📋 Description

• Develop realistic scenarios pertaining to short- and long-term disability claims, elimination periods, own-occupation and any-occupation definitions, residual and partial disabilities, offsets, recurrent disabilities, and management of claim duration.

• Generate claim determinations, benefit calculations, summaries of medical and vocational evidence, transferable-skills analyses, return-to-work strategies, and decisions on appeals.

• Compose exemplary reference responses that meet the quality standards expected of seasoned disability professionals.

• Evaluate AI-generated responses against structured criteria for definitional precision, evidentiary backing, accuracy in benefit calculations, and adherence to procedural fairness.

• Detect improperly applied disability definitions, unsupported functional conclusions, overlooked offsets, erroneous benefit calculations, and lapses in documenting the administrative record.

• Deliver written feedback utilized by the research team to enhance model performance.

• Engage in onboarding sessions and calibration meetings.

⛳️ Requirements

• A minimum of 2 years of professional experience in disability claims adjudication, disability underwriting, vocational rehabilitation, or leave and absence management.

• Familiarity with at least one program type: group short-term disability, group long-term disability, individual disability income, statutory disability, or life waiver of premium.

• Knowledge of contract definitions, elimination periods, offsets, pre-existing-condition clauses, and maximum benefit durations.

• Capability to assess medical, occupational, and financial evidence and articulate a defensible determination with documented reasoning.

• Exceptional written analytical skills, balanced judgment, and keen attention to detail.

• Ability to differentiate between claim adjudication and the clinical decisions made by treating providers, as well as formal legal counsel.

• Possession of a CRC, CDMS, CCM, CPDM, RN, or a similar clinical or vocational credential.

• Experience with ERISA administrative records, appeals processes, or litigation support.

• Knowledge in individual disability income underwriting, including occupational classification and financial underwriting.

• Experience in coordinating Social Security, workers compensation, or other income offsets.

• Familiarity with FMLA, state leave programs, or ADA accommodation interactions.

🏝️ Benefits

• Minimum of 20 hours per week (preferably 40+).

• Position available immediately.

• Reasonable accommodations provided upon request.