LTD Claims Examiner I

Reliance Standard Philadelphia , PA 19107

Posted 1 month ago

Job Information

  • Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim.

  • Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line.

  • Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner.

  • Conducts in-depth pre-existing condition or contestable investigations if applicable.

  • Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc.

  • Develops and maintains on-line claim data (and paper file if applicable).

  • Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.

Analysis and Adjudication

  • Fully investigates simple claims, and submits recommendation to higher level examiners or leadership for review and payment approval.

Case Management

  • Manages assigned case load of 60-80 simple cases.

  • Partners with supervisor or Sr. Examiners to develop desk management capabilities and priorities to ensure all claims commitments are met in the timeframe expected.

Reliance Standard Insurance Company is an equal opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, veteran status or any other consideration made unlawful by applicable federal state or local laws.

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LTD Claims Examiner I

Reliance Standard