PLADS Sr Life Case Manager

Job Summary

Handles a complex case load of Life and Accidental death claims. Makes timely, accurate, and customer focused claim decisions. Serves as resource and mentor for other team members. Proactively engages legal, compliance, employer, and other informational internal and external sources to gather relevant data and compares it to the applicable contract and procedures. 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 Life and Accident new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards; handles the most complex claims; reaches out to obtain relevant medical and police, legal , employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract 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 claims 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 claims 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

 • Mentors and coaches new team members and participates in projects supporting the team's business initiatives

• Performs other related duties as required

Education & Experience Required

• Minimum Required High School Diploma

• Minimum Required 3 - 5 years of Life industry claims experience

•  Minimum Required Demonstrated proficiency in product specific areas of Life or Disability as well as federal and state regulations governing these products and services

Education & Experience Preferred

• Preferred Bachelor’s Degree in a related field.

Or an equivalent combination of education and experience

Job Knowledge & Skills

• Strong familiarity with claim management concepts

• Strong understanding of medical terminology/pathology/anatomy

 • Articulate verbal and writing skills, decision making, meeting deadlines, working with confidential information

• Strong skills with Microsoft Office and other software applications

 • Customer service skills

• Stress tolerance

• Ability to multi-task and prioritize

• High level of attention to detail

• Can work under pressure

• Confidence to make claim decisions

• Results-driven

Competencies

• Acting with Integrity 
• Communicating Effectively 
• Pursuing Self-Development
• Serving Customers
• Supporting Change 
• Supporting Organizational Goals 
• Working with Diverse Populations