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Dexian · 22 hours ago

Long Term Disability Insurance Specialist

United States

Part-time

Remote

Mid, Senior Level

$45/hr - $50/hr

3+ years exp

Dexian is a company dedicated to making a meaningful impact in the lives of customers and communities. They are seeking a Claims Consultant responsible for evaluating individual disability income insurance claims, making decisions in accordance with policy provisions, and ensuring exemplary customer service and inventory management.

ConsultingHuman ResourcesInformation TechnologyProfessional ServicesStaffing Agency

Hiring Manager

Shivani Kumari

Responsibilities

Independently manages an assigned caseload of, and makes claims decisions on, moderately complex claims which consists of pending, ongoing, disputed and appeal reviews

Provides timely, balanced, and accurate claims reviews, documentation, and decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations

Provides timely and detailed written communication throughout the claim evaluation outlining comprehensive claim status and/or claim determinations

Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members during claim evaluations

Interacts and communicates effectively with claimants, customers, health care providers, attorneys, brokers, and family members throughout the claim evaluation

Compiles file documentation and correspondence requiring extensive policy analysis and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available

Collaborates with both external and internal resources, such as physicians, attorneys, vocational consultants, and CPAs to gather data such as medical/occupational information to ensure claim decisions are well-reasoned and thorough

Identifies, clarifies, and reconciles inconsistencies when gathering information during claim evaluations and collaborates with underwriting and Fraud Waste and Abuse resources, as needed

Identifies offsets and proficiently calculates monthly benefits, to include COLA, Social Security Offsets, Residual Disability, and other non-routine payments

Provides timely and detailed written communication during the claim evaluation, which outlines and supports the status of the evaluation and/or claim determination

Addresses and resolves escalated customer complaints in a timely and thorough manner, including drafting written responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to litigation support partners

May represent Clients at depositions and trials

Qualification

LTD insurance claims experienceIDI insurance claims experienceRisk managementCritical thinkingDecision makingCustomer serviceConceptual thinkingManage systemsInterpersonal skillsOrganizational skillsTime managementCreative problem-solvingCommunication skills