Senior Disability Representative

Chicago, IL 60604

Post Date: 08/02/2018 Job ID: 2532

PRIMARY PURPOSE:  To analyze reported claims, determine benefits due and make timely payments and adjustments; to medically manage disability claims; to coordinate investigative efforts and to thoroughly review contested claims; to evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level. 
ESSENTIAL FUNCTIONS and RESPONSIBILITIES:

  • Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan. 
  • Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. 
  • Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions. 
  • Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. 
  • Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. 
  • Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. 
  • Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. 
  • Refers cases as appropriate to supervisor and management. 
  • Negotiates settlement of claims up to designated authority level. 
  • Maintains professional client relationships. 


ADDITIONAL FUNCTIONS and RESPONSIBILITIES: 

  • Performs other duties as assigned. 
  • Supports the organization's quality program(s). 


WORK ENVIRONMENT: 

When applicable and appropriate, consideration will be given to reasonable accommodations. 

 

Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines 

 

Physical: Computer keyboarding, travel as required 

 

Auditory/Visual: Hearing, vision and talking 

 

NOTE: Credit security clearance, confirmed via a background credit check, is required for this position. The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.

SKILLS & KNOWLEDGE: 
  • Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures 
  • Excellent oral and written communication, including presentation skills 
  • PC literate, including Microsoft Office products 
  • Analytical and interpretive skills 
  • Strong organizational skills 
  • Ability to work in a team environment 
  • Excellent negotiation skills 
  • Ability to meet or exceed Performance Competencies

EXPERIENCE: Two (2) years benefits or disability claims management experience or successful completion of Disability Representative training required.


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