LTD Claim Analyst / Sr. LTD Claim Analyst (DI & Accident) - Omaha, NE
Job no: 496262
Work type: Full Time Regular
Categories: Claims/Claims Processing
Ensures the accurate, prompt and thorough evaluation and management of disability claims by analyzing and determining appropriate action steps while adhering to both internal and external regulation and ensuring an industry leading customer experience.
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 policyholders.
Requires independent decision making on claims situations and critical thinking based on established policy and guidelines. 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 claimants, employers, medical professionals (including physicians) and other sources as needed (underwriting, legal, special investigations, etc.)
Actively engages in lean process design by participating in the identification and elimination of non-value add activity.
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.
- 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 job posting is reflective of the LTD Claims Analyst essential functions, qualifications, and physical requirements. The Sr level has variable essential functions, qualifications and physical requirements. Competency and skill set will determine level of placement within the posted job family.
- Ability to work in a fast paced, diverse and multi-faceted environment.
- 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; goof written and verbal communication skills.
- 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; proficient in Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
- 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 consistently meet deadlines.
- Ability to move from dependent to independent decision-making.
- Ability to handle escalated customer concerns.
- Ability to adapt to a changing environment.
- Basic knowledge of medical terminology.
- Analytical and decision-making skills.
- Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations, work flexible shifts and occasional mandatory overtime based on business needs.
- 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.
- Ability to adhere to policies, practices, and procedures in a business environment.
- Ability to demonstrate engagement, resilience, and a willingness to be a change champion.
- College degree or equivalent industry experience.
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.
Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer, Minorities/Female/Disabled/Veteran
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.
Advertised: Central Daylight Time
Applications close: Central Daylight Time
Back to search results Refer a friendApply now