Disability Case Manager

Alight Solutions•US-IL-Illinois-Virtual, TN

4d•$55,000 - $65,000•Remote

About The Position

This role is responsible for administering and case managing assigned Group Short Term Disability claims, ensuring adherence to plan provisions, state and federal guidelines, and established protocols. The Disability Case Manager will collaborate with other team members within STD, LTD, and Risk Management resources. Alight is a leading benefits administration provider focused on helping clients build a healthier and more financially secure workforce by unifying the benefits ecosystem. They offer a comprehensive total rewards package, flexible working arrangements, and have been recognized as a "Great Place to Work" for seven consecutive years.

Requirements

Demonstrate independent problem-solving and decision-making ability.
Able to clearly communicate claim decisions and contract language verbally and in written correspondence.
Demonstrate math aptitude, ability to multitask, and analytical skills.
Have a 4-year college education or equivalent work/education experience.
2 years of disability claim management experience (STD), or other previous Group insurance experience.
Experience with candidate regulatory and compliance standards.

Responsibilities

Administer and case manage assigned Group Short Term Disability claims.
Follow plan provisions, state and federal guidelines, and established protocols.
Work jointly with other team members within STD, LTD, and Risk Management resources.
Use efficient and effective means of proactive outreach to obtain and/or dispense information to and from claimants, departmental managers, physicians, HR, Payroll, or any other sources.
Communicate claim status and decisions via telephone and in writing.
Initiate communications to claimant, physician, and/or plan holder to obtain information, make assessment, and initial claim decision.
Prioritize and review new claims to adhere to established departmental productivity.
Meet productivity requirements for handling "fast track" disability claims with limited durations.
Investigate and analyze claim information to determine coverage and benefit eligibility.
Perform pre-existing condition investigation and draft adverse determination letters, if applicable.
Determine disability by comparing functionality with job requirements.
Set up claims for initial benefit approval, including physician statements and medical records.
Follow claim management procedures and identify potential return to work and job accommodation opportunities.
Utilize claim management resources, such as MDA (Medical Disability Advisor), and other disability guidelines.
Work with the goal of returning claimants to active work status.
Assess claims when other sources of income are received to ensure accurate offsets are applied.
Recalculate benefits as needed, determining under/overpayments.