Disability Claims Specialist

    POSITION SUMMARY:

    The position of Claims Consultant offers ample opportunity to have an impact within the organization. The ideal candidate should have the ability to provide quality Disability Case Management Services in an appropriate and cost effective manner. The individual will perform all aspects of technical claims management, manage claim duration, make payment recommendations for Loss of License (LOL), Short Term Disability (STD) and/or Long Term Disability (LTD) claims, ensure customer satisfaction and identify process improvements.

    KEY OBJECTIVE: 

    Under the direction of the Manager of Claims Administration or a designated supervisor, the Claims Consultant investigates and processes claims promptly, equitably and within established best practices guidelines.

    MAJOR DUTIES AND RESPONSIBILITIES - Duties may include, but are not limited to the following:

    • Is the designated contact, overseer and ultimately responsible for the handling of all assigned accounts.
    • Confirms coverage of claims by reviewing plan documents, policies and other information submitted in support of claims.
    • Contacts, interviews and obtains statements from pilots, witnesses, physicians, attorneys, employers, union representatives, etc…to secure necessary claim information.
    • Evaluates facts supplied by investigation to determine coverage, if any, and the extent of the company’s obligation to the claimant under the policy or plan document.
    • Maintains a current physical and electronic filing system to review, update and track the progress and status of claims.
    • Accomplishes tracking and review efforts by mail, email, and telephone contacts. Face to face contacts are conducted as needed.
    • Prepares reports and makes recommendations based on investigation, denials of claims, and individual evaluation of parties involved.
    • Counsel individual pilots on their disability policies.
    • Provide administrative and logistical support for individual pilot’s as well as communicating with their employer as necessary
    • Provide service consistent with URAC Standards and CMSA Standards of Practice as well as internal Quality Assurance Guidelines to clients who are either receiving benefits or inquiring about benefits under their particular disability plan.

    MINIMUM REQUIREMENTS:

    • Minimum of 2 – 5 years of STD/LTD claims processing experience.
    • Minimum of 2 – 5 years of strong Customer Service experience.
    • Bachelor’s Degree, or equivalent experience
    • Experience interfacing with client (s) and the ability to deal with them in a professional manner.
    • A genuine desire and commitment to customer service
    • Detail oriented with strong problem solving skills.

    NECESSARY KNOWLEDGE AND SKILLS:

    • Ability to work independently and assimilate learning materials on many different subjects from various sources.
    • Excellent interpersonal and communication skills, both oral and written, with extremely strong phone skills.
    • Computer savvy with ability to learn applicable business software applications for use in an automated work environment, including strong systems, Internet, Windows, Word and Excel experience.
    • Should have knowledge and understanding of regulatory and legislative impact
    • Should have knowledge and understanding of financial management, profitability, reporting and delivery.
    • Builds and maintains a positive image for Harvey W. Watt & Company

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