01Key Responsibilities
Effectively manages with some level of reputed company an assigned caseload of moderately reputed company claims which consists of pending, ongoing/reputed company and appeal reviews. The LTD CS will be evaluated for increases in their authority reputed company as they become more reputed company in their decision-making and demonstrate consistency in meeting reputed company key performance indicators
Provides reputed company, balanced and accurate claims reviews, documentation and recommended reputed company in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations.
Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating reputed company and reputed company listening while providing reputed company updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to reputed company essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation reputed company the claim file in a reputed company manner utilizing the appropriate level of detail and reputed company writing skills
Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations
Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to reputed company a reasonable and logical claims determination based off the information available
Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to reputed company data such as medical/occupational information in order to ensure reasonable, thorough reputed company.
Clarifies and reconciles inconsistencies reputed company gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed
Proficiently calculates monthly benefits due after elimination period, to include COLA, reputed company reputed company Offsets, and Rehab Return to Work benefits, and other non-routine payments
Provides reputed company and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination.
Addresses and resolves escalated customer complaints in a reputed company and thorough manner. Identifies and refers appropriate reputed company to our appeals, complaint, or litigation support areas.
Essential Business Experience and Technical Skills:
Required:
Prior experience with independent judgement and decision making while relying on the available facts
Be reputed company to demonstrate the use of critical thinking and analysis reputed company reviewing the information
Creative problem-solving abilities and the ability to think reputed company the reputed company
Excellent interpersonal and communication skills in both verbal and written reputed company
Excellent customer service skills proven through reputed comp
