• Analyzes assigned claims and determines benefits due.• Informs claimants of documentation required to process their claim and timeframes. • Manages claim to ensure compliance with plan provisions. • Provides appropriate documentation to LTD Manager for reporting purposes. • Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.• Refers cases to LTD Supervisor, LTD Manager, or Project Manager.• Negotiates settlement of appropriate claims within designated authority level. • Makes claim payments and revisions to benefit amounts. Communicates status on decisions to client, claimant and supervisor. • Calculates and collects overpayments.

• Supervises multiple teams of examiners and/or several technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.• Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.• Provides technical/jurisdictional direction to examiner reports on claims adjudication.• Compiles, reviews, and analyzes management reports and takes appropriate action.• Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.• Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.• Reviews reserve amounts on high cost claims and claims over the authority of the individual examiner.• Monitors third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client.• Maintains contact with the client on claims and promotes a professional client relationship; makes recommendations to client as suggested by the claim status; and provides written resumes of specific claims as requested by client.• Assures that direct reports are properly licensed in the jurisdictions serviced.• Ensures claims files are coded correctly and adequate documentation is made by claims examiners.

• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.• Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).• Communicates with the claimants providers to set expectations regarding return to work.• Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.• Manage the disability claims and Paid Family Leave on multiple accounts. • Communicate with the claimant and client• Train new colleagues • Wage loss calculations• Long Term Disability claim management

• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.• Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).• Communicates with the claimants providers to set expectations regarding return to work.• Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.• Manage the disability claims and Paid Family Leave on multiple accounts. • Communicate with the claimant and client• Train new colleagues • Wage loss calculations

• Physician and claimant outbound calls• Create new claims, data entry• Various claims support • Providing customer service to clients and colleagues