Ensures the accurate, prompt and thorough evaluation and management of disability claims by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry leading customer experience. This role has direct impact on the success of BSD from both a financial and persistency (customer retention) perspective.
Performs end to end claims evaluation, management and adjudication for Disability claims beginning at the point of notification through the maximum benefit/duration of the claim with the primary accountability being accurate and timely decision making of approved or denied liability benefits for the duration of the claim by managing to the appropriate duration based upon the claim facts, effective and efficient claim management, as well as communication of decisions both verbally and in writing to claimants and employers.
Requires independent decision making on less complex claims situations and some critical thinking. Claims analysis includes: eligibility determination for initial and ongoing benefits based on medical information received, contract analysis, customer service, fraud detection and awareness, financial calculations, interpreting medical and vocational information and adhering to all statutory / governmental regulations. This includes analyzing information received, and determining if additional information is required to make a benefits decision. Regularly communicates with employers, medical professionals (including physicians) and claimants.
Essential Job Functions:
Makes decisions in partnership with management throughout the life of the claim (initial adjudication and ongoing claims management) based upon claim facts, thorough evaluation and gathering of pertinent information to formulate appropriate action plans.
Develops case files that demonstrate appropriate decision making based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
Develops appropriate business relationships and communications with claimant, broker, sales organization, vendor partners, employer and internal partners (e.g. underwriting, legal, etc.). Communications demonstrate a solid level of customer service and professionalism that support the values of Mutual of Omaha.
Thoroughly documents all actions and rationales to ensure clear understanding of actions and ease of review.
Initiates regular and appropriate communication with claimants, employers and medical professional(s) throughout the life-cycle claims. This includes initial and ongoing claim decisions.
Reviews and determines continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions, and determining any changes in claim status or benefits. Requires interaction and coordination with internal and external partners including brokers, sales organization, clinical and physician resources, vocational experts, vendor partners and financial resources.
Accurately determines financial liability based on salary, other income sources, medical / vocational information and contract language. Has limited autonomy to approve initial and ongoing payments based upon holistic file evaluation. Responsible for accurate and timely transition of claims to the LTD organization.
Communicates changes in liability or claim status to claimants, policyholders, and appropriate Home Office departments.
Provides various reports to policyholders per contract requirements with a high level of customer service.
Determines eligibility based on contract language, payroll records, and other supporting documentation.
Adheres to ERISA and other federal/state laws concerning group disability insurance.
Demonstrates flexibility and ability to support unique customer requirements.
Creates written letters for the purpose of providing concise explanations to claimants regarding: claims determinations.
Remains abreast of industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.
This position requires extensive or prolonged typing/keyboarding.
This position is in a fast-paced, high volume environment with set production goals.
This position requires sitting over 66% of the time.
This position requires Visual Acuity at 20 inches (or less) over 66% of the time.
This position is multifaceted and diverse, requiring many different skill-sets in order to be effective including:
Demonstrate a beginning level ability to analyze and interpret insurance provisions and contracts.
Ability to comprehend and apply insurance regulations to claim situations.
A solid level of customer service (written and verbal).
Ability to calculate disability benefits based on contract provisions and offset management.
Some knowledge / skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel.
Good organizational skills, attention to detail with a increasing degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency.
Ability to meet deadlines.
Ability to move from dependent to independent decision-making.
Ability to diffuse situations.
Ability to adapt to a changing environment.
Basic knowledge of medical terminology.
Analytical and decision-making skills.
Demonstrate the ability to increase independent decision making and critical thinking capabilities.
Good verbal and written communication skills.
Proficient with personal computer, Microsoft applications and Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.
Ability to manage claims on an ongoing basis, potentially for multi- year durations.
Fair, equitable, and consistent treatment of claims is necessary for accurate financial payments and policyholder retention and satisfaction.
For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.
If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
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To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.
Advertised: Dec 3, 2019 09:00 AM Central Standard Time
Applications close: Dec 17, 2019 11:55 PM Central Standard Time
Mutual Of Omaha Insurance Company