About The Position

In this role, you’ll make timely, accurate, and customer-focused claim decisions. You’ll collaborate with clinical, vocational, financial, and employer resources to gather and analyze data, compare it to policy terms, and determine claim outcomes. You may also support claim settlement efforts, ensuring optimal outcomes and compliance with regulatory standards.

Requirements

  • High School Diploma required; college degree preferred.
  • 3+ years of LTD claims experience required.
  • Solid understanding of disability claim processes, medical terminology, and legal/regulatory frameworks.
  • Proven analytical, negotiation, and conflict management skills.
  • Strong judgment, attention to detail, and a commitment to compassionate service.
  • Excellent written and verbal communication skills.
  • Ability to work independently and as part of a team.
  • Proficiency in the Microsoft Office Suite.

Nice To Haves

  • Experience with LTD Claim settlement efforts is a plus.
  • Experience with Fineos a plus.
  • Pursuing a NY Independent Adjuster license or industry designations (e.g., FLMI, CPDM) is a plus.

Responsibilities

  • Evaluate new and ongoing LTD claims promptly and accurately.
  • Analyze medical, vocational, and financial information against policy terms and procedural guidelines.
  • Apply contract language and procedural guidelines to claim decisions.
  • Document claim decisions thoroughly in the system.
  • Communicate effectively with internal and external stakeholders.
  • Build and maintain claim management plans for optimal outcomes.
  • Identify and support settlement opportunities as applicable.
  • Collaborate with internal resources (e.g., Actuaries, CPAs, Medical Clinicians) to support claim adjudication.
  • Ensure compliance with ERISA, HIPAA, Fair Claim Settlement Practices Acts, and other statutory regulations.
  • Deliver empathetic, customer-first service throughout all interactions.
  • Foster a collaborative and professional team environment.

Benefits

  • Flexible full-time or hybrid telecommuting arrangements
  • Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%
  • Paid time away including vacation and sick time, flex days and ten paid holidays
  • Give back to your community and double your impact through our company matching

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume

What This Job Offers

Job Type

Full-time

Career Level

Mid Level

Education Level

High school or GED

Number of Employees

501-1,000 employees

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service