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Job Discription
Assesses eligibility of long-term and short-term disability applications based on the policy provisions of specific disability plan using managed claims model. Adjudicate Life claims following policy provisions. Newly hired employees may perform at the Claims Specialist III level if they have 4 or more years of comparable claims experience.
Essential Duties and Responsibilities: Includes the following, other duties may be assigned.
Evaluate long-term and short-term disability applications using the managed disability claim process.
Evaluate and process Life claims.
Perform direct telephonic interviews with applicants and also with the medical providers of service.
Document conversations held with claimants, medical providers, employers or persons acting on insured’s behalf after each interaction according to procedures.
Demonstrate responsive, knowledgeable and courteous service in all customer interactions with both internal and external customers.
Complete detailed SOAP (Subjective, Objective, Assessment and Plan) procedures on each initial application received. Continue ongoing claim management with continued assessment and plan portion of SOAP notes documented in file.
Enter accurate claim information in computer system to ensure correct claim payment amount, correct benefit dates and document dates for future claim reviews.
Maintain proper claim file organization in chronological order and according to internal guidelines.
Develop appropriate claim strategy for each approved claim including use of medical and vocational vendors of service when appropriate.
Investigate other income sources insured’s may be entitled to through Social Security, Workers Compensation and State Pension plans or other entities. Calculate and recover claim overpayments as a result of other income sources consistent with group department guidelines.
Initiate transition of claim review six months prior to the own occupation / any occupation phase.
Mentor newer claims specialists.
**Madison National Life Insurance is now a division of Horace Mann.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Education and/or Experience: Bachelor’s Degree with at least two years of experience or High School Degree with at least four years of experience
Skills and/or Abilities: Candidate must possess excellent communication skills including the ability to convey routine and complex information to all external contacts in a clear, concise, and persuasive manner. Must possess thorough understanding of short and long-term disability concepts and related benefit information. Candidate must also possess effective listening skills and must appropriately respond to questions asked in a clear and concise manner. Ability to exercise superior judgment with regard to confidential information required along with high level math skills.
Computer Skills: Working knowledge of Microsoft Word, Excel and Outlook. Familiarity with claims operating systems.
Madison National Life Insurance provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
