•Accountable for conducting interviews with claimants, clients, and physicians (via phone, mail/e-mail) to obtain confidential medical history and other income benefits, to set claim process expectations, and to answer questions during the initial claim management process.•Evaluate the claim and plan to determine eligibility for LTD benefits, calculate and apply applicable offsets and taxes, gather and confirm other income benefits, including effective dates and amounts for benefits such as but not limited to State-Mandated Benefits, Social Security Benefits, Worker’s Compensation, Pension/Retirement benefits, etc. •Ability to maintain a caseload of 100 or more based on department needs.•Conduct ongoing interviews with claimants at specified intervals to certify their eligibility and gather additional information regarding their prognosis and other income benefits.•Refer appropriate claims to Internal Resources (such as Clinical Case Managers, Vocational Rehab Specialists, etc.)•Answer complex claim and plan questions from incoming callers.•Compiles file documentation and correspondence requiring extensive policy and factual detail. •Collaborates effectively with external and internal resources, such as physicians, attorneys, vocational consultants, and CPAs, to gather data such as medical/occupational information to ensure reasonable, thorough decisions.•Clarifies and reconciles inconsistencies when gathering information during claim evaluations •Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination

•Communicates with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of STD benefits.•Conducts investigations to determine whether or not to accept liability and to what degree.•Approves or denies benefits accordingly.•Responds to various written and telephone inquiries including eligibility, approval/denial determinations, status, and continuation or closure of benefits.•Ability to maintain a caseload of 150-200 or more based on department needs.•Updates and accurately documents system and claim files on actions taken.•Establishes future action plan and case direction.•Observed strict procedures to maintain data and plan participant confidentiality.•Resolved issues and inquiries from plan participants regarding health and welfare benefits and deductions through telephone, email, and in-person interactions.•Explained benefits to plan participants in easy-to-understand terms to educate each on available options.

•Entered loss information into appropriate claims applications, reviewed and evaluated the incoming loss documents for complete and accurate information.•Received first notice of loss, reviewed and/ or located policies, validated coverage applied to the claim, and determined the appropriate line of business and loss type.•Received claim reports and information inquiries from internal and external business partners and research, then respond.•Reviewed application systems to determine the presence of duplicate claims.•Validated and located missing policy information before entering default information, along with reviewing special handling instructions for claims routing.

• The position requires operating a multi-line phone system, clerical duties, insurance verification, patient scheduling, filing medical records, administration and office management, customer service, customer contact, and customer advisory.•Greets patients and visitors and directs them accordingly.•Obtains authorization as needed to process patients for services needed.•Explains all required paperwork and forms to patients and ensures proper completion of all paperwork.•Answers incoming telephone lines in accordance with company procedures and directs the caller accordingly.•Checks out patients either via Occusource or manually according to procedure and distributes records according to the Employer's protocols.•Files paperwork, medical records, and correspondence according to defined company procedure.