Disability Claims Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the disability claims job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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S Schimmel

Saul

Schimmel

4199 Demond Parkway

Dallas

+1 (555) 247 7673

4199 Demond Parkway

Dallas

Phone

p +1 (555) 247 7673

Experience Experience

New York, NY

Disability Claims Manager

New York, NY

Kub-Jakubowski

New York, NY

Disability Claims Manager

Support the Director in developing and implementing business plans
Identify and implement ongoing productivity and service enhancements
Work with union representatives for both WSIB and Benefits to facilitate proper case management for unionized employees
Serve as lead technician and subject matter expert on difficult and complex cases, and on Company practices and procedures
Review and approve key claim decisions and provide direction for the management of claims
Provides technical direction to claim team members on claims adjudication for LTD Claims
Perform claim audits within the team, identify opportunities and develop and implement action plans to address opportunities/findings

Philadelphia, PA

Long Term Disability Claims Manager

Philadelphia, PA

Hessel and Sons

Philadelphia, PA

Long Term Disability Claims Manager

Manages both new claims and open claims equally and maintains decision times
Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
Adheres to standard timeframes for processing mail, tasks and outliers
Stays abreast of ongoing trainings associated with role and business unit objectives
Pays all covered claims accurately and timely
Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
Responsible for staffing within the unit, including selection, retention, career development and performance management

present

Phoenix, AZ

Short Term Disability Claims Manager

Phoenix, AZ

Collier Inc

present

Phoenix, AZ

Short Term Disability Claims Manager

present

Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
Exhibits claim management performance according to quality and compliance standards
Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
Executes on all customer performance guarantees

Education Education

Bachelor’s Degree in Customer Service

New York University

Bachelor’s Degree in Customer Service

Skills Skills

Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources
Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Pay all covered claims accurately and timely
Execute on all customer performance guarantees
Adhere to standard timeframes for processing mail, tasks and outliers
Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices

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11 Disability Claims resume templates

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Senior Disability Claims Specialist Resume Examples & Samples

Responsible for the adjudication of disability claims utilizing a multidisciplinary claim management model to
Ensure objective, fair and thorough claim adjudication
Comply with practices and procedures and regulatory requirements
Provide the highest level of customer service and manage reputational risk
Read, validate and interpret financial statements and tax returns and apply to the decision-making process
Effectively communicate and build rapport with team members, stakeholders and business partners using a variety of techniques and collaboration from initiation to close
Resolves the more complex conflicts and issues and escalates to others as appropriate
Minimum of 3 years of directly relevant disability claims experience
Minimum of one industry course completed, three preferred and working toward an industry designation (e.g. ALHC, FLMI, HIAA)
Ability to multitask and balance multiple goals and priorities
Demonstrated ability to effectively deal with customers in a manner that is professional with a high degree of customer service
Bilingualism in both French and English, written and spoken is considered an asset for this role

Disability Claims Analyst Resume Examples & Samples

Responsible for assigned long term disability claims utilizing a multidisciplinary claim management model to
Ensure objective, fair and thorough claim adjudication
Comply with practices and procedures and regulatory requirements
Provide the highest level of customer service and manage reputational risk
Develop and implement claim management and return to work strategies for their assigned caseload
Recognize and investigate complex issues and escalate, when appropriate these issues to their mentor, Lead or manager
Effectively manage multiple client needs and internal job demands
Strong analytical and decision making skills
Ability to multitask and balance multiple goals and priorities
Demonstrated ability to effectively deal with customers in a manner that is professional with a high degree of customer service
Ability to effectively manage change

Disability Claims Specialist Resume Examples & Samples

Develop and implement claims management and return to work strategies on their assigned caseloads
Given the very sensitive nature of the information gathered in the adjudication process, extreme care must be exercised in the handling of a claim in order to guard against any breach of confidentiality
Assesses, researches and analyzes numerous disability contracts. Documents the appropriate next steps while effectively applying the adjudication process. Professionally communicate outcomes to our clients
Resolves more complex conflicts and issues and escalates to others as appropriate
Post secondary education
Minimum of 2 years of directly relevant disability claims experience
Working on one industry course, one course completed preferred and working toward an industry designation (e.g. ALHC, FLMI, HIAA)
Experience in effectively managing more complex claims
Proven skills in conflict resolution
Ability to effectively manage change
Fluency in both English and French (written and spoken) would be considered an asset for this role
LI-DC1

Team Lead, Short Term Disability Claims Resume Examples & Samples

Demonstrated leadership skills a must
Supervisory experience preferred, but not required
Prior experience with Claim Management processes
Ability to problem solve independently
Demonstrated focus on continuous improvement
Strong communication (verbal and written) and time management skills required
Proficiency in MS Word and Excel
Demonstrated strong Customer Service skills and ability to partner
Understanding of Absence, STD and LTD product lines with experience of at least five plus years in absence/disability claim organization preferred

Manager, Disability Claims Resume Examples & Samples

Experience managing Short Term and Long Term Disability claims
Experience in disability appeals preferred
Litigation experience (depositions, mediations)
Supervisory/Management experience, including proven staff development skills
Effective written and oral communication to both internal and external customers
Proven ability to effect organizational change
Experience in Process redesign efforts

Group Disability Claims Director Resume Examples & Samples

Effective collaboration with multiple business partners across and outside of the organization in the development and execution of comprehensive insurance and disability management strategies including technology and data management solutions that result in RBC Life attaining a profitable position in the market as the preferred Group Benefits Solutions carrier of choice.,
Leading, coaching and developing a team of Disability Claim Managers and individual contributors to achieve personal and team success,
Consistent execution of effective claim management routines aimed at driving improved client health and wellness outcomes,
Driving best in class client service delivery to attract and retain profitable business
Strong focus on the management of multiple to risks: legal, legislative and reputational,
Management of the operational excellence standards required to mitigate legal, regulatory, compliance, anti-money laundering, terrorism and reputational risks
Strategic Direction: Contribute proactively and effectively as a member of the Life and Health Claims team. Contribute to creating the strategic direction for the Group Disability Product and Claims management practices and procedures. Assist in developing the Group Division business plan and overseeing the execution of tactics with objectives to: increase potential for profitable growth, and increase market share

Manager, Disability Claims Resume Examples & Samples

Providing reports and analysis of trends
Attending meetings with business partners
Flexibility to manage a modified assignment when business needs dictate due to volume or for absence coverage
RN designation, or appropriate credentials in either Physical or Occupational Therapy is required
7-10 years of relevant clinical and or industry experience
Prior experience as a leader of people is highly desirable
Ability to lead, facilitate and participate in relevant department, division and GI projects and meetings
Must possesses excellent analytical skills, creative thinking and courage
High level of organizational awareness
Ability to partner effectively with all levels of claim and clinical/vocational staff and management
Excellent communication, presentation and time management skills

Life & Disability Claims Auditor Resume Examples & Samples

Performs audits of and may adjudicate high dollar claims while maintaining acceptable levels of claims inventory and age
Completes and maintains detailed documentation of audit which includes decision methodology, system or processing errors, and monetary discrepancies which are used for financial reporting and trending analysis. Provides feedback on processing errors; identifies quality improvement opportunities and initiates basic requests related to coding or system issues, where applicable
Refers overpayment opportunities to Recovery Team

Short Term Disability Claims Analyst Resume Examples & Samples

Ensures claims integrity and compliance with established procedures, timing requirements and regulatory guidelines
Monitors other sources of income that coordinate with Short Term Disability Benefits. Can calculate, explain, and recover overpayments on disability claims
Coordinates with Long Term Disability Claims team when benefits integrate

Disability Claims Manager Resume Examples & Samples

Overall responsibility for performance of the team, including ensuring thorough, fair and objective claim evaluations and decisions, and providing the highest level of service to our customers
Serve as lead technician and subject matter expert on difficult and complex cases, and on Company practices and procedures
Review and approve key claim decisions and provide direction for the management of claims
Triage and monitor work/caseload within the unit to ensure that staff is assigned an appropriate caseload
Responsible for staffing within the unit, including selection, retention, career development and performance management
Perform claim audits within the team, identify opportunities and develop and implement action plans to address opportunities/findings
Support the Director in developing and implementing business plans
Implement and effectively manage change
Identify and implement ongoing productivity and service enhancements
Leads projects and initiatives across Life and Health Claims
Responsible for ensuring that all complaints and appeals within the unit are responded to appropriately and within service standards
Ensure effective utilization of resources in order to maintain cost effective and appropriate risk management activities
Responsible for reviewing key management reports and developing action plans to address issues and variances, including risk management and customer service issues

Disability Claims Assistant Resume Examples & Samples

Assist Short Term Disability Case Managers, Long Term Disability Case Managers, Disability Claims Technical Specialists, and/or Claims Technicians with their daily tasks in an effort to help deliver a superior customer experience
Complete timely follow-up requests and inquiries for medical records or other pertinent information
Communicate with claimants, employers, and various medical professionals / vendors to gather information regarding the application for and ongoing management of disability benefits
Respond to various written and telephone inquiries, including requests for and receipt of information as well as the status of claims
Issue accurate payment of vendor invoices for various claim specific requests including medical records and medical examinations
Continually and accurately document our claim system and claim files on actions taken
Strong typing / keying skills required
Excellent telephonic communication and customer service skills applied to elicit information and convey information to a variety of audiences clearly, succinctly and diplomatically
Excellent organizational skills to manage multiple priorities and tasks
Strong written communication skills to accurately and clearly capture claims status, actions taken and decisions made
Ability to work independently and as a member of a team to achieve individual and team objectives
Knowledge of and experience with data entry and Microsoft Office Suite applications (Word, Excel, Outlook) required
2-5 years of experience in the customer service and / or insurance industry is preferred

Disability Claims Consultant Resume Examples & Samples

Assess appeals that have reached the 2nd level of the appeal process at Sun Life Financial
Govern the critical financial components related to overpayments
Contribute to the effectiveness of our Quality Management program by ensuring process adherence and accuracy to quality controls
Liaise with the Office of the Ombudsman in responding to plan member concerns with respect to customer service and claim decisions
Coach and mentor Disability Case Managers, regarding quality case management ensuring that all components including the contract, medical, functional and vocational components are considered as part of the overall assessment of the claim decision
Demonstrate an excellent knowledge of group insurance, disabilities and claims management strategies
Exhibit solid communication, organizational and people skills in order to effectively drive positive case management outcomes
Ensure a client focused approach permeates in your coaching as you mentor both Case Managers and Case Management Consultants, on the disability and financial risks associated with disability claims management
Contribute to a dynamic work environment by identifying opportunities to continuously improve processes to better meet our service excellence, quality and financial commitments to our customers
Contribute to the ongoing business retention and growth by cultivating excellence in your team
Manage second level appeals in accordance to our claims practices, procedures adhering to our philosophies and principles, within the services standards set for the organization
Review weekly governance reports to ensure compliance with practices and processes. Work with claims operation to take further action on claims as needed
Co-ordinate Quality Management Review Activity
Provide suggestions to improve the client experience through the 2nd level appeal process by participating in initiatives to review current processes to identify opportunities to improve the processes or improve team consistency
Work with Team Managers to identify and close any gaps on case management deficiencies that surface through coaching
Provide feedback and direction to the Abilities Case Manager on continuously improving their case management skills
Partner with other Portfolio Business Experts, Case Management Consultants and Trainers to facilitate continuous professional development within the region, where appropriate

Manager, Short Term Disability Claims Resume Examples & Samples

Approves and makes more complex claim management related financial decisions consistent with company guidelines for assigned area(s) of responsibility
Collaborates with internal and/or external stakeholders to ensure effective service delivery of more complex claims for assigned area(s) of responsibility
Collaborates with sales offices to ensure effective service delivery of claims for assigned area(s) of responsibility
Completes regular quality audits of assigned area(s) of responsibility claim/team members' work; records results and counsels staff to bring work to or above standards
Ensures all assigned area(s) of responsibility claims, eligible or ineligible for payment, conform to quality, production standards and specifications
Ensures claims processing is consistent with applicable policies, procedures and department guidelines for assigned area(s) of responsibility
Identifies and communicates claims trends and issues to management. Develops mitigation plans
Identifies process inefficiencies and cost reductions. Develops and recommends mitigation plans
Manages the processing and administration of all aspects of more complex claims for his/her assigned area(s) of responsibility ensuring accurate and timely claim management
Monitors and evaluates overall metrics for team productivity and takes appropriate action to meet or exceed standards
Provides more complex technical guidance to claim team members on claims adjudication for assigned area(s) of responsibility
Reviews and resolves more complex escalated issues and concerns for assigned area(s) of responsibilities
Reviews regular quality audits of for assigned area(s) of responsibility claim team members work, analyzes results and counsels staff to bring work to or above standards
5+ Years of experience in { Claims that directly aligns with the specific responsibilities for this position, including 2+ years of managerial, supervisory, and/or demonstrated leadership experience(Required)
4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) in Insurance (Minimum Required)

Senior Manager Short Term Disability Claims Resume Examples & Samples

Manage claims and customer service activities to optimize and sustain sound risk analysis, performance, profitability and customer satisfaction
Responsible for the leadership and development of the team of Claims examiners
Develop, implement, and evaluate procedures to correct identified issues leading to more accurate, on-time claims service to the policyholder, increase the overall effectiveness and efficiency of the unit and ensure uniformity and consistency in all procedures

Senior Disability Claims Analyst Resume Examples & Samples

Manage client and advisor relationships over the individual disability claim life cycle
Determine claim requirements
Request and evaluate medical & financial information to reach claim decision
Handle claim referrals from team members and assist other analysts with claims as necessary
Coordinate investigative efforts ensuring appropriateness of referral of claims to internal resources and outside vendors
Disability team phone queue support
Understand regulatory requirements related to individual disability claim contracts
Provide input to improve process and procedures
Disability insurance claims experience
Associate (2-year) or equivalent with 3+ years of experience
Understanding of medical terminology, disability duration guidelines and medical management practices
Understanding of contract law
Excellent organizational skills and the ability to effectively prioritize tasks
College degree or equivalent with 3+ years of experience

Short Term Disability Claims Associates Resume Examples & Samples

Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims
Sets claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner
Obtains backup documentation, as necessary, to substantiate claim or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources
May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs
Must be able to utilize legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology in order to make final decisions to approve or further investigate claims
Bachelor degree with a minimum requirement of 3.0/4.0 GPA
0-2 years of customer service experience
Excellent organization skills required due to the nature of internal and external contacts and exposure to highly confidential information
Proven ability to successfully cope in a fast-paced, demanding environment
End user computing skills, including proven proficiency in MS Office Outlook, Word, Excel and PowerPoint and Windows 7 with the ability to learn new and complex computer systems
Strong mathematical skills for calculations and adjustment of claim payments
Requires independent judgment to settle claims in accordance with policy provisions
Proven ability to work independently on own initiative and in a team environment
Demonstrated ability to work to deadlines with a high level of accuracy and attention to detail

Disability Claims Analyst Resume Examples & Samples

Review and render determinations on Long Term Disability claims
Initiate and maintain appropriate level of communication within ERISA standards through the claim review and investigation process
Respond to all inquiries generated relative to Long Term Disability claims within established service timeframe
Provide accurate claim decisions in accordance with Policy, State and Federal guidelines
Adjudicate Long Term Disability claims

Disability Claims Case Manager, Trainee Resume Examples & Samples

Make claim determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and using case management resources
Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation
Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
Bachelor’s degree with a minimum 3.0 cumulative GPA; additional requirements may apply
Proven track record through internships, co-ops or other business/leadership experience

Associate Disability Claims Case Manager Resume Examples & Samples

An opportunity to develop the knowledge, skills and capabilities needed to conduct investigations
Learn to make liability determinations
Understand how to manage group disability claims
Through the training program and on-the-job training, you will learn how to apply the appropriate contractual provisions, legal guidelines, case management resources and claim procedures, concepts, principles, and protocols to risk manage claims
Excellent ability to multi-task
Ability to demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills
Knowledge of insurance, medical terminology, and case management in same or similar discipline preferred

Z-se-disability Claims Case Manager, Trainee Resume Examples & Samples

An opportunity to develop the knowledge, skills and capabilities needed to conduct investigations
Understand how to manage group disability claims
Ability to demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills
Knowledge of insurance, medical terminology, and case management in same or similar discipline preferred

Associate Disability Claims Case Manager Resume Examples & Samples

Ability to gather/analyze information from multiple sources to make decisions
Excellent organizational skills to manage multiple priorities and tasks for large caseloads
Ability to work independently and as a member of a team to achieve individual and team objectives
Knowledge of and experience with data entry and Microsoft Office Suite applications (Word, Excel, Outlook) required
Knowledge of legal liability, insurance coverage or medical terminology preferred. a

Senior Disability Claims Consultant Resume Examples & Samples

Manage your litigated block of cases with a strong proactive customer service focus, exhibiting expert skill in both disability and litigation management and following relevant practices, processes, and guidelines
Represent Sun Life in a highly professional manner at mediations, examinations for discovery, pre-trials, trials, grievance arbitrations and at any other judicial or quasi-judicial proceeding
Instruct our legal counsel on the final disposition of litigated claims
Handle final level appeals and other escalated matters in thorough, timely and effective manner, following relevant practices and processes, again with a strong proactive customer service focus
Provide leadership in complex case management
Identify issues and solutions on both litigated and non-litigated cases that require follow-up within the disability operations
Consistently build strong working relationships with members of our legal services department, disability claims operations, and other stakeholders, working proactively and in partnership with them
Contribute to the ongoing business retention and growth by building strong working relationships with our customers and by your proactive engagement with all customers
Demonstrate an excellent knowledge of group insurance, and disability case management strategies
Build a strong knowledge of litigation management strategies
Exhibit strong communication, organizational and people skills
Help prioritize work in order to meet customer expectations
Work to improve your quality outcomes
Build strong, effective relationships with your manager, and other members of the litigation management team, working in partnership with them to help the team meet expected business outcomes
Coach and mentor other team members as opportunities arise
Create and deliver presentations to disability claims operations based on common trends within litigation or on other relevant topics
Take an ownership role in your own development
LI-WJ1

Disability Claims Case Manager Associate Resume Examples & Samples

For an assigned caseload of short-term disability claims, and in accordance with established procedures/protocols, apply appropriate contractual provisions, legal guidelines, and case management resources to make claim determinations
Bachelor’s Degree preferred, or relevant, progressively responsible practical experience required, to include at least two years in a customer service environment
Knowledge of legal liability, insurance coverage or medical terminology preferred

Disability Claims Manager Resume Examples & Samples

Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources
Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
Pay all covered claims accurately and timely
Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
Stay abreast of ongoing trainings associated with role and business unit objectives
Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
1 year minimum of professional experience strongly preferred
HS Diploma or GED required. Bachelor’s degree strongly preferred
Proven track record of successfully driving results in a complex matrix environment is a (+)
Additional experience administering FMLA and/or State Leaves is a (+)
Ability to manage multiple and changing priorities
Knowledge of legal liability, insurance coverage and medical terminology is a (+)

Asst Life & Disability Claims Analyst Resume Examples & Samples

Obtain, analyze and investigate medical, financial and contractual information to make effective and timely claim decisions
Monitor and follow up on outstanding items to ensure compliance with regulations, service timing, and quality guidelines
Bachelor's degree with 1+ years of experience preferred, but not required, or a high school diploma or equivalent with 3+ years of related work experience
Ability to maintain a high degree of accuracy, pay strict attention to detail, maintain confidentiality, and work within the grey
Computer skills and typing proficiency

Disability Claims Manager Resume Examples & Samples

Manage and act as a liaison between Management/WSIB for all WSIB cases for any occupational Injuries/illnesses that occur on site
Manage all non-occupational injury/sickness claims with employees as well as 3rd party Insurance provider
Investigate and challenge fraudulent claims
Maintain a database of all occupational and non-occupational cases
Manage the successful Return To Work process and amend as needed
Manage the restricted workforce database and work with Managers to ensure the accommodation process is followed
Facilitate communication with on-site Health Centre to ensure proper flow of information regarding any claims and disability related items
Work with union representatives for both WSIB and Benefits to facilitate proper case management for unionized employees
Liaise with Benefits Administrator on all unionized claims where necessary
Support 2nd step grievance and arbitrations as required
You have a post-secondary education preferably related to Disability Management
You have over ten (10) years of experience handling complex disability claims
You have working knowledge of medical conditions, recovery guidelines and resulting restrictions/impact on function
You have working knowledge of WSIB regulations
You have working knowledge of Microsoft Office Suite
You have excellent organizational skills with the ability to prioritize, be flexible and multi-task
You have excellent communication skills (both verbal and written) and an analytical approach to problem solving
You will have experience working with disability claims in a unionized environment
You have demonstrated the ability to challenge the status quo,

Long Term Disability Claims Manager Resume Examples & Samples

Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Execute on all customer performance guarantees
Manage both new claims and open claims equally and maintains decision times
Adhere to standard timeframes for processing mail, tasks and outliers
High School Diploma or GED required. Bachelor's degree strongly preferred
1 year minimum of professional experience is strongly preferred
Experience in hospital administration, medical office management, financial services and/ or business operations is a (+)
Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
Proficiency with MS Office applications is required (Word, Outlook)
Strong written and communication skills demonstrated in previous work experience
Specific experience with collaborative negotiations
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. Must have Demonstrated analytical and math skills

Long Term Disability Claims Manager Resume Examples & Samples

Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
Executes on all customer performance guarantees
Exhibits claim management performance according to quality and compliance standards
Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed
Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
Mentors and coaches new hires as needed
Minimum of 18 months disability claim management experience
Ability to thrive in a fast-paced environment and meet deadlines
Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
Critical attention to detail

Long Term Disability Claims Manager Resume Examples & Samples

Adhere to standard time frames for processing mail, tasks and outliers
Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset
Demonstrated analytical and math skills

Short Term Disability Claims Case Manager Associate Resume Examples & Samples

Calculate liability for claims, applying appropriate offsets such as social security, workers compensation, and third parties
Continually and accurately document system and claim files on actions taken. Establish future action plan and case direction
Strong written communication skills to accurately and clearly capture claims status, actions taken and decisions made

Short Term Disability Claims Manager Associate Resume Examples & Samples

Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits
Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation
Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
Excellent telephonic communication and customer service skills to elicit information and convey decisions to a variety of audiences clearly, succinctly and diplomatically

Manager, Disability Claims Resume Examples & Samples

Build a stable, collaborative team of disability management professionals through recruiting ideal candidates who will fit with our culture, have strong customer service focus and expert skill in disability management, and provide ongoing coaching for the team’s continued development
Build strong relationships with our Plan Sponsors, working in partnership with them to address their workplace absence issues
Demonstrate an excellent knowledge of group insurance, disabilities and claims management strategies
Exhibit solid communication, organizational and people skills in order to effectively manage client relationships
Act as the primary resource for your assigned team, giving staff direction on overall office targets, workload management, difficult cases, department workflow and processes
Proactively address clients’ needs and address complaints that may be escalated to you
Help your team to prioritize work items in order to meet client service standards and Sun Life best practice guidelines
Contribute to a dynamic work environment by identifying opportunities to continuously improve processes to better meet our service excellence, quality and financial commitments to our customers
Contribute to the ongoing business retention and growth by cultivating excellence in your team and continuous proactive engagement with your assigned clients to ensure full understanding of their evolving needs and how we can meet and exceed their expectations with respect to their group disability program
Performance management assessments for direct reports
Development and growth of team
Recruiting and resolution of employee performance issues
Quality assurance and achievement of service standards and monthly targets
Establishing and deepening client relationships as a primary representative of Group Disability for your assigned block of clients
Working with Business Development, you will sometimes be required to present at finalist presentations or act as a resource in developing our business
Foster a strong relationship with Business Development to support proactive client management for assigned clients

Disability Claims Case Manager Associate Resume Examples & Samples

(STD) Reviews and assesses claim details and contract provisions to determine whether or not to accept liability. Approves or denies benefits accordingly. Establishes future action plan
(LTD) Reviews existing claim file and system documentation. Establishes future action plan
Communicates with claimants and providers verbally and in writing and responds to inquiries
Makes appropriate claim payments
Consults with appropriate medical claim resources as needed
Updates files and accurately documents system and claim files on actions taken
Refers claims that exceed unit guidelines to more senior Case Managers
Maintains the established customer service, production, and quality standards
May be assigned to provide guidance and assistance to others
H.S. diploma plus 4 or more years of business experience with some exposure to insurance products
Demonstrated decision making, communication, and computer skills required
Strong ability to process multiple tasks quickly while providing excellent customer service
Knowledge of medical terminology and/or claim processing experience preferred

Short Term Disability Claims Manager Resume Examples & Samples

Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Pays all covered claims accurately and timely
Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
Ability to handle potentially high levels of call volume from customers and clients
Adheres to standard timeframes for processing mail, tasks and outliers
Ability to serve as a point person for projects and/or reporting functions
Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
Provides assistance to Senior Claim Manager with responsibilities as needed
Identifies issues, proposes solutions and follows through on commitments
Minimum of 3 years disability claim management experience
Exceptional customer service standards and delivery