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STD Claim Examiner I

Phoenix, AZ, United States

Posted on
Jun 29, 2020

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Job Description:nJob Information KEY RESPONSIBILITIES *other duties as assigned* Obtains and analyzes data for thorough, fair, objective, and timely adjudication of Short Term Disability claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the contract. Research * Develop an understanding and working knowledge of disability products, policies and contracts. * Develop an understanding of the applicable contract/policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements. * Become familiar with reference materials and tools regarding medical, vocational and disability issues. * Develop an operating knowledge of the applicable disability claims system(s). * Develop basic medical and technical claims skills and an understanding of claim practices and procedures. * Utilizes most efficient means to obtain claim information. Analysis and Adjudication * Fully investigates all relevant claim issues. * Provides payment or denials promptly and in full compliance with department procedures and regulations. * Involves technical resources (Social Security specialist, medical resources, and vocational resources) at appropriate claim junctures. * Researches contract specifics regarding eligibility and pre-existing formulas in reference to specific claim. * Pro-actively communicates with claimants, policyholders, and physicians to resolve investigations issues. Case Management * Utilizes appropriate intervention for the characteristics of each claim. * Manages assigned case load of 110-120 simple and some complex cases with oversight from independently. * Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system. Customer Service * Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. * Establishes, communicates, and manages claimant and policyholder expectations. * Documents claim file actions and telephone conversations appropriately. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR RELATED EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* * Work experience in decision-making and information analysis. * Demonstrated prioritization and organization skills. * Experience working in confidential/protected identification environments. * Good math and calculation skills. Education * Associates Degree (AS/AA), Bachelors Preferred * Business, Finance, Social Work, Human Resources or related Required Competencies Customer Service: Promptly acknowledges customers' needs, both internal and external. Ensures customers' needs are handled in a timely and appropriate manner. Creates a positive impression. Communication/Relationship Skills: Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback. Communicate/respond appropriately to varied audiences/tasks. Exhibits teamwork, honors commitments. Problem Solving/Decision Making: Anticipates, analyzes and defines problems. Develops and assesses alternative solutions as necessary. Makes appropriate decisions in a timely manner. Analyzes impact of decisions. Productivity: Work is accomplished quickly and accurately. Takes responsibility for actions. Prioritizes work effectively and uses time efficiently. Accomplishes goals and objectives. Dependability: Makes/fulfills commitments. Consistently works independently, meets deadlines, and accepts responsibility for his/her actions. Adheres to all attendance requirements. Prompt, well prepared and ready to contribute. **MEMBERS ONLY**SIGN UP NOW***. Insurance Company is an equal opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, veteran status or any other consideration made unlawful by applicable federal state or local laws.n}

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