Senior Disability Claims Examiner – LTD

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

📋 Description

• Accountable for delivering outstanding customer service while overseeing an assigned portfolio of approximately 95 to 100 Long-Term Disability claims.

• Expected to apply judgment and evaluate risk while collaborating with various business partners to make claim decisions.

• Collaborate with medical and vocational experts to assess disability and promote return-to-work objectives.

• Provide an exceptional customer experience that distinguishes Prudential from competitors, ensuring that commitments and deliverables to customers are met.

• Communicate through telephone, email, and text with employees, employers, attorneys, and other stakeholders.

• Review and analyze medical records, utilizing resources as necessary.

• Carry out financial calculations.

• Acquire a comprehensive understanding of the Prudential claims system, policies, procedures, contracts, and the regulatory and statutory requirements for the claim products managed.

• Apply contract and policy provisions to guarantee accurate eligibility and liability determinations.

• Exhibit and apply analytical and critical thinking skills.

• Confirm ongoing liability and formulate strategies for appropriate return-to-work opportunities.

• Document objective, clear, and technical justifications for all claim decisions and effectively communicate these decisions to customers through both oral and written methods.

• Utilize a wide array of resources, materials, and tools to make claims decisions.

• Ensure a timely and exceptional customer experience by accurately processing claims and responding to inquiries while maintaining expected service and quality standards.

• Operate in a fast-paced environment with tight deadlines while balancing multiple priorities.

• Provide technical guidance and/or mentorship to other claims staff as needed.

• Function autonomously as well as collaboratively within a team framework.

⛳️ Requirements

• Over 4 years of experience in Long Term Disability Claim Management is required.

• Outstanding customer service abilities.

• Capacity to resolve complex claim situations with minimal supervision.

• Strong skills in claim/risk management and technical expertise in contract interpretation and administration.

• Proven ability to interact positively and effectively with challenging customers.

• Excellent written and verbal communication skills as demonstrated in prior work experience (preference for bilingual communication in Spanish and English).

• Exceptional organizational and time management abilities with the capability to multitask and prioritize deadlines.

• Proficient in managing multiple and changing priorities.

• Detail-oriented; capable of analyzing and researching contract information.

• Proven ability to operate with a sense of urgency.

• Experience in consistently meeting/exceeding individual professional expectations and team objectives.

• Demonstrated analytical and mathematical skills.

• Ability to exercise critical thinking, risk management skills, and sound judgment.

• Capacity to adapt, quickly problem-solve, and communicate effective solutions.

• High degree of flexibility to accommodate the evolving needs of the organization.

• Self-motivated, independent, with a proven ability to work effectively both individually and as part of a highly collaborative team.

• Commitment to continuous improvement.

• Dedication to fostering a work environment that promotes Diversity and Inclusion.

• Strong computer literacy and skills, with the ability to navigate multiple systems; proficiency in PC-based applications such as Excel and Word.

🏝️ Benefits

• Competitive base salaries with potential for annual bonuses at all levels.

• Medical, dental, vision, life insurance, and disability coverage.

• Paid Time Off (PTO) and various leave options, including parental and military leave.

• 401(k) plan with company match (up to 4%).

• Company-funded pension plan.

• Wellness Programs offering up to $1,600 annually for reimbursement of items that support personal wellbeing needs.

• Work/Life Resources to assist with topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.

• Education Benefit to help finance traditional college enrollment for obtaining an approved degree and many accredited certificate programs.

• Employee Stock Purchase Plan: Shares may be acquired at 85% of the lower of two prices (Beginning or End of the purchase period) after one year of service.

• Eligibility to participate in a discretionary annual incentive program, subject to the governing rules, where awards, if any, depend on various factors including individual and organizational performance.