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PLADS LTD Case Manager

The Company:  true
The Location: 

FL, US Remote, US

The Division: 
Job Id:  1799

Job Summary

Makes timely, accurate, and customer-focused Long-Term Disability claim decisions. Proactively engages clinical, vocational, employer, financial, and other informational internal and external sources to gather relevant data, and compares it to the applicable contract/administrative agreement and procedural documents. Conducts an analysis of data and engages peers and management as appropriate. Communicates verbally and in writing an accurate and comprehensive decision. Maintains performance at or above departmental metrics.


Principal Duties & Responsibilities

• Makes timely, accurate, and customer-focused Long-Term Disability, new and ongoing claim decisions on a mixed degree of complex claims; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible


• Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claim management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claim team operational metrics


• Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimant's and employer's trust and confidence; anticipates customer’s needs and takes action as appropriate


• Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence


• Performs other related duties as required


Professional - Education & Experience

High School Diploma


5 years of LTD industry claims experience


Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services


1+ years of Supervisory, Managerial, and/or leadership experience (Preferred)


Utilization Review Experience and/or experience using specific mendical and/or behavioral health criteria or protocols (Preferred)


2 or more years of experience in disability management industry managing claims  (Preferred)


Or an equivalent combination of education and experience.


Job Knowledge & Skills

• Strong understanding of disability claim management concepts

• Solid understanding of medical terminology/pathology/anatomy

• Ability to verbally articulate clearly, concisely and explain complex situations

• Superior writing skills

• Confident with independent decision making

• Ability to consistently meet deadlines

• Proven ability to work with confidential information

• Moderate skills with Microsoft Office and other software applications

• High level of customer service skills/phone skills

• Strong ability to multi-task and prioritize

• Must have a high level of attention to detail

• Results-driven

• High attention to deliver on departmental/company procedures/practices

• Ability to work Independently

• Strong Negotiation skills

• Proven ability to multi-task