Saltar al contenido
País
India
Acuerdo de trabajo
Tiempo completo
Esquema de Trabajo
Híbrido
Asistencia de reubicación disponible
No
Fecha de publicación
09-Jul-2024
ID del trabajo
3405

Descripción y requisitos

Basic Function

Responsible for structuring Long-Term Disability (LTD) claims based on claim receipt date.  Support the claim adjudication (claim specialist) team with the initial claim setup in accordance with the plan provisions, identify potential recurrent claims, and utilize several systems to verify coverage.  Determine LTD eligibility.  Prepare and send acknowledgment to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD - stand-alone & bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, Claims Manager (stateside supervisors), EE, ER through emails/systems. Assign the claims to the CS in case missing along with declining the duplicates and send back claims. Capture details directly from Claimant & ER for CCU No Call work and observe these claims for 3 days consecutively.

Essential Functions

 

   Analyze, validate and process transactions as per Desktop procedures (L3 & L4)

   Analyze and research all discrepancies.

   Research & investigate and resolve outstanding items

   Determine eligibility and applicable plan provisions while meeting timeliness goals

   Clear and accurate written and verbal communication (Scripted and Templatized) with employee, 
      employer & stateside resources by email

   Establish action plans for each file to bring claims to resolution

   Utilize internal and external specialty resources to maximize impact on each claim file

   Utilize Intellis and ACS (SIR) to update and maintain accurate data record

   Use PC programs to increase productivity and performance

   Ensure that the assigned targets are met in accordance with SLA and Internal standards

   Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process 
      Excellence

   Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values 
      and meeting key measures.

   Ensure adherence to established attendance schedules

   Sedentary work - involves sitting most of the time

   Close visual acuity - viewing a computer terminal and extensive reading

   Talking - expressing or exchanging ideas by means of the spoken word

   Capturing the medical, personal & employment details from Employee, Health Care Provider(via email - free flow communication)