Disability Specialist- RN with clinical experienced needed ASAP
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
o Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.
o Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
o Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.
o Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.
o 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.
o Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
o Evaluates and arranges appropriate referral of claims to outside vendors for surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
o Refers cases as appropriate to supervisor and management.
o Negotiates settlement of claims up to designated authority level.
o Maintains professional client relationships.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
o Performs other duties as assigned.
o Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university in nursing, social work or vocational rehabilitation is preferred. At least one of the following licenses is required: RN, LVN, CRC, COHN, CVE, LPC or LCSW.
Experience
Three (3) years benefits or disability claims management experience required.
Skills & Knowledge
o Knowledge of ERISA regulations, required offsets and deductions, disability duration and medical management practices and Social Security application procedures
o Excellent oral and written communication, including presentation skills
o PC literate, including Microsoft Office products
o Analytical and interpretive skills
o Strong organizational skills
o Ability to work in a team environment
o Excellent negotiation skills
o Ability to meet or exceed Performance Competencies
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.Estimated Salary: $20 to $28 per hour based on qualifications.
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