Job Information
Crawford & Company Disability Benefit Specialist in Brea, California
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
Why Crawford?
Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time.
At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us.
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 purpose, vision and values. Learn more at www.crawco.com.
When you accept a job with Crawford, you become a part of the One Crawford family.
Our total compensation plans provide each of our employees with far more than just a great salary
Pay and incentive plans that recognize performance excellence
Benefit programs that empower financial, physical, and mental wellness
Training programs that promote continuous learning and career progression while enhancing job performance
Sustainability programs (https://www.crawco.com/about/social-responsibility) that give back to the communities in which we live and work
A culture of respect, collaboration, entrepreneurial spirit and inclusion
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.
#LI-DV1
Posted Date1 month ago(11/11/2024 6:18 AM)
Requisition ID2024-26544
Job LocationsUS-CA-Brea
Position TypeRegular Full-Time
CategoryClaims
Business UnitBUS_TPA US
