Disability Benefit Specialist (Ca)

Crawford & Company Brea , CA 92821

Posted 2 weeks ago

Excellence In Everything We Touch

Position Summary

The Disability Benefit Specialist will be relied upon to obtain and evaluate information in order to determine eligibility of benefits. Must be able to demonstrate a general knowledge of disability contracts, policies, and products and continued understanding of medical and vocational issues. Uses disability claims system for timely and accurate claims review, and effective communication of rationale for claims action. Communicates decisions effectively verbally and in writing to impacted parties such as Employees and Employers. Establishes future action plans and forms strategies for return to work based on the utilization of medical management resources, including the Client Advocate.

Responsibilities

  • Manages assigned caseload of disability claims for Short Term/Long Term Disability.

  • Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.

  • Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.

  • Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.

  • Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.

  • Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.

  • Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards

  • Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.

  • Analyzes claims activity and prepares reports for clients/carriers and management as needed

  • Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.

  • Effectively works together in a team setting.

  • Other duties as assigned.

Requirements

  • Bachelor's degree or equivalent experience required.

  • 2 + years of STD/LTD claims adjudication.

  • Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations

  • Ability to work independently while assimilating various technical resources

  • Computer knowledge in excel, word, web based systems, etc

  • Good verbal and written communication skills

  • Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures

  • Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.

  • Strong ability to identify, analyze and solve problems.

  • Effective interpersonal skills capable of dealing with external sources and all levels of employees.

Preferred:

  • Experienced in the TPA or self-administration services is desired

  • Experience with FMLA/State leave claims is a plus

About Us

Think all TPAs are the same? Think again. With Broadspire, our leading global third-party administrator (TPA), Crawford & Company is the consultative outsourcing partner that adapts to businesses' needs and challenges at any point of the claims processing journey. We offer casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics.

As part of the One Crawford family, Broadspire brings together the best and brightest people in the industry to deliver smart, thoughtful solutions to our clients, and we are guided by our collective value system: RESTORE.

At Crawford, we:

  • Respect our culture of integrity and ethical behavior, while embracing the unique talents of the individual and encouraging an ownership mentality among everyone.

  • Are Empowered to advance the company mission and take ownership of our individual career progression.

  • Promote Sustainability through a corporate culture in which employees are good stewards of their communities.

  • Emphasize Training and an environment where employees continually seek and share knowledge and are engaged and satisfied with their work.

  • Are One Crawford, embracing a global mindset that's inclusive, agile, mission-focused, and customer-focused.

  • Give Recognition, participating in an environment where people are rewarded for jobs well done.

  • Embody an Entrepreneurial Spirit, sharing a passion to succeed, innovate, and outpace our competitors.

We believe in leading by example at work and in our communities. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in mission, vision and values. Learn more at www.crawfordandcompany.com.

In addition to a competitive salary, Crawford offers you:

  • Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries

  • On-going training opportunities through every stage of your career

  • Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.

Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.


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Disability Benefit Specialist (Ca)

Crawford & Company