Disability Claims Analyst
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Job Location:
Cincinnati, OH - USA
Monthly Salary:
Not Disclosed
Posted on:
17 hours ago
Vacancies:
1 Vacancy
Job Summary
provide disability case management and claim adjudications based on medical documentation and the applicable disability plan interpretation including determining benefits due and making timely payments and adjustments.
and analyze medical information (i.e. diagnostic tests office notes operative reports etc.) to determine if the claimant is disabled as defined by the disability plan.
to make required outreaches for missing claims documentations to employee physicians or employers.
the appropriate clinical resources in case assessment (i.e. duration guidelines in-house clinicians).
with clinical and vocational resources to evaluate disability and support return to work goals.
approves and authorizes assigned claims and determines benefits due pursuant to a short term disability plan.
clearly with the claimants and clients to set expectations on all aspects of claims process either by phone andor written correspondence.
client critical deliverables manages the overall workload and second-level process escalation.
benefits due makes timely claims payments and or approvals and adjustments for Workers Compensation State Short Term Disability and other disability offsets.
cases as appropriate to team lead and clinical case management.
for managing the day-to-day workload and first-level process escalation and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
ideas to management on continuous improvement and service level management.
other duties or participates in special projects as assigned
