Disability Claims Associate

at  Protective

Under general direction, provides ADA members with detailed, expert- level claims handling and superior service. Responsible for all aspects of Income Protection and Office Overhead claim handling, such investigation of; coverage, liability, and red flags. Conducts medical case management, financial analysis, and determines benefit eligibility based upon the Policy.

QUALIFICATIONS

• Bachelor’s Degree in business (or related field), or equivalent work experience desired
• High school diploma required.
• At least 2 or more years of experience in claims, Insurance, benefits, and contractual products (disability).
• Prior Disability Claims experience strongly preferred.
• Demonstrated proficiency in reviewing complex medical records.
• Industry-related courses/designations (ARM, ICA, LOMA, Etc.) preferred.
• Demonstrate critical thinking, organization, problem solving, data analysis, and prioritization skills.
• Professional, integrity-driven, detail-oriented, and resourceful team player, with the ability to work independently.
• Excellent verbal and written communication skills, including the ability to articulate comprehensive medical and financial terminology.
• Proficient ability to navigate and effectively use Word and Excel products, as well as the ability to learn OnBase and CAB, along with other technologies.
• Confidence and critical thinking skills necessary for for making a claim determination.
• Adept at collaborating and coordinating with both Internal & External Contacts.
  Protective’s targeted salary range for this position is $61k to $89k. Actual salaries may vary depending on factors, including but not limited to, job location, skills, and experience. The range listed is just one component of Protective’s total compensation package for employees.
  This position also offers additional incentive opportunities through an annual incentive based on individual and Company performanc

• Effectively manages a caseload of disability claims with department and policy guidelines, including but not limited to turnaround, policy adherence, beneficiary designations, and quality control.
• Analyzes, investigates, and initiates disability claims decisions, including authorization of payments and denials.
• Performs thorough reviews of medical and financial documentation, along with a detailed coverage analysis with critical thinking concepts.
• Communicates effectively both oral and written with policyholders, members, hospitals, physicians, attorneys, etc.
• Responds to attorney inquiries and may be involved in litigation processes.
• Arranges outside medical and/or investigative services with our vendors.
• Promotes and maintains high customer focus by communicating effectively, drafting detailed correspondences related to our claim decision.
• Possesses advanced knowledge of Contracts, medical terminology, financial documents, detailed investigations, and collateral assignments.