Long Term Disability Claims Analyst
CurrentHands-on, client-focused Claims Manager with over 7 years of experience managing a robust caseload of long-term disability (LTD) clients. Leverage knowledge of medical terminology and benefit calculations to assure payment of appropriate benefit and offset application, evaluate LTD at each stage of the claim’s life, and accurately interpret and apply policy to each claim. Skilled in assessing and recommending appropriate vocational or medical specialty, and peer review, IME, occupational, or employability assessment. Strong interpersonal and communication skills with ability to interact with clients, employees, medical teams, business partners, and other stakeholders to gather information, offer recommendations, and make decisions.Assess claimants for payment eligibility based on qualification. Consult with clients and medical providers, gathering medical information and ensuring review by appropriate clinical staff. Verifying review and conclusions align with policy requirements. Document claim information clearly, concisely, and accurately. Effectively manage accounts by responding to inquiries, negotiate, arbitrate, and resolve issues, ensuring team meets all performance KPIs.• Achieve overall quality reviews including TL/SCM within standard.• Consistently have higher number of decisions completed (3-4 weekly) by accurately assessing claims based on all available information and making decisions without the need for additional oversight.• Conduct EA, quality and other block reviews to ensure financial and decisional accuracy, identify training opportunities, and provide timely, appropriate feedback to drive continuous improvement. • Train and mentor new hires.