LTD (Long Term Disability) Claim Manager Pittsburgh

Work Schedule:
The first 10 weeks of training will take place onsiteat The Vision (116 15th Street Pittsburgh PA 15222) Monday through Friday. After training employees will be evaluated. Once they demonstrate proficiency the role will transition to a hybrid schedule: Remote: Mondays and Fridays and Onsite: Tuesday Wednesday & Thursday.

Role Overview:
The LTD Claim Manager is responsible for accomplishing training requirements learning and applying the LTD concepts gained in classroom and on the job training to successfully manage an assigned LTD caseload. The Claim Manager is responsible for the development of strategic case plans informed by customer & key stakeholder interactions leveraging Technical Coaches and Team Leaders where appropriate. As a key customer-facing role the Claim Manager will communicate with customers employers and treating providers.

The LTD Claim Manager will manage an assigned caseload of Long-Term Disability cases. This includes management of claims with longer duration and evolving medical conditions. LTD Claim Managers will have meaningful and transparent conversations with their customers and clinical partners to gather the information most relevant to each claim. It may also require potentially complex monthly benefit calculations. The Claim Manager will also evaluate customer eligibility and interact with internal and external customers including but not limited to customers employers physicians internal business matrix partners and attorneys etc. to gather the information to make the decision on the claim.

What Youll Do:
As a Long-Term Disability Claim Manager with oversight and on an increasing scheduled basis you will -

• Proactively manage your block of claims by regularly talking with and knowing your customers their level of functioning and having a command of case facts for each claim in your block.
• Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint
• Determine customer eligibility by reviewing contractual language and medical documentation interpret information and make decisions based on facts presented
• Leverage claim dashboard to manage claim inventory to determine which claims to focus efforts on for maximum impact
• Have probing conversations with customers and employers regarding return-to-work opportunities and communicate with an action-oriented approach.
• Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
• Ask focused questions of internal resources (e.g. nurse behavioral doctor vocational) and external resources (customer employer treating provider) to question discrepancies close gaps and clarify inconsistencies
• Have detailed phone conversations with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
• Execute on all client performance guarantees
• Respond to all communications within customer service protocols in a clear concise and timely manner
• Make fair accurate timely and quality claim decisions
• Adhere to standard timeframes for processing mail tasks and outliers
• Support and promote all integration initiatives (including Family Medical Leave Life Assistance Programs Integrated
• Personal Health Team Your Health First Healthcare Connect etc.)
• Clearly articulate claim decisions both verbally and in written communications
• Understand Corporate Compliance Policies and Procedures and best practices
• Stay abreast of ongoing trainings associated with role and business unit objectives
  
  

What Youll Bring:

• High School Diploma or GED required with 3 years minimum of professional experience or bachelors degree strongly preferred
• Experience in hospital administration medical office management financial services and/ or business operations is a ()
• Comfortable talking with customers and having thorough phone conversations
• Excellent organizational and time management skills
• Strong critical thinker
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
• Ability to focus and achieve production goals through high quality work
• Proficiency with MS Office applications is required (Word Outlook Excel)
• Strong written and verbal skills demonstrated in previous work experience
• Proven skills in positive and effective interaction with challenging customers
• Experience in effectively meeting/exceeding individual professional expectations and team goals
• Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset
• Comfortable giving and receiving feedback
• Flexible to change and highly cooperative
• Demonstrated analytical and math skills

Critical Capabilities:

• Critical Thinking
• Trust and Transparency
• Bias for Action
• Leads with Agility
• Customer Orientation

Work Schedule:
The first 10 weeks of training will take place onsite at The Vision (116 15th Street Pittsburgh PA 15222) Monday through Friday. After training employees will be evaluated. Once they demonstrate proficiency the role will transition to a hybrid schedule: Remote: Mondays and Fridays and Onsite: Tuesday Wednesday & Thursday.

Onsite Amenities:
Employees working onsite will have access to the following amenities:

• Fitness center
• Tenant lounge
• Nearby retail
• Bike storage
• Outdoor space
• Concierge services
• Dry cleaning
• EV charging stations
• Puttery mini golf
• The Roaming Bean Coffee
• Tapville Social
• Onsite free parking

It is recommended that all qualified candidates apply to this posting as soon as possible. Residents of Colorado are hereby notified that the deadline to apply is two weeks from the Posting Date listed above.

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