Disability Case Manager (Temporary) - Virtual

Alight•Wyoming, NV

5d•$38,500 - $50,000•Remote

About The Position

The temporary Disability Case Manager administers and case manages assigned Group Disability claims in accordance with plan provisions, state and federal guidelines, and established protocols. The role works jointly with team members in Short-Term Disability (STD), Long-Term Disability (LTD), and Risk Management resources. The manager obtains and provides claim information through proactive outreach to claimants, departmental managers, physicians, Human Resources, Payroll, and other sources. They communicate claim status and decisions by telephone and in writing, investigate claims, assess coverage and benefit eligibility, and manage claims toward appropriate benefit decisions and return to work where possible. This is a virtual position. Virtual interviews are conducted by video, and occasional travel to a physical office may be required. The position is temporary. The listed salary range is $38,500 to $50,000 USD.

Requirements

Demonstrated independent problem-solving and decision-making ability.
Ability to clearly communicate claim decisions and contract language verbally and in writing.
Math aptitude, ability to multitask, and analytical skills.
Four-year college education or equivalent work/education experience.
Two years of disability claim management experience or other prior Group insurance experience.
Experience with applicable regulatory and compliance standards.

Responsibilities

Use effective proactive outreach to obtain or provide information from and to claimants, departmental managers, physicians, Human Resources, Payroll, and other sources.
Communicate claim status and decisions by telephone and in writing.
Initiate communications with claimants, physicians, and/or plan holders to obtain information, make assessments, and reach initial claim decisions.
Prioritize and review new claims to meet established departmental productivity requirements, including handling fast-track disability claims with limited durations.
Investigate and analyze claim information to determine coverage and benefit eligibility.
Perform pre-existing condition investigations and draft adverse determination letters when applicable.
Determine disability by comparing the claimant’s functionality with the requirements of the job.
Set up claims for initial benefit approval, including obtaining physician statements and medical records.
Follow claim management procedures and identify potential return-to-work and job-accommodation opportunities when applicable.
Use claim management resources, including the Medical Disability Advisor (MDA) and other disability guidelines, with the goal of returning claimants to active work status.
Assess claims when other sources of income are received, apply accurate offsets, and recalculate benefits as needed to determine underpayments or overpayments.