PLADS STD Case Manager

Job Summary

Makes timely, accurate, and customer-focused Short-Term Disability and/or Absence Management claim decisions. Proactively engages clinical, vocational, employer, financial, and other informational internal and external sources to gather relevant data and compares it to the applicable contract/administrative agreement and procedural documents. Conducts an analysis of data and engage peers and management as appropriate. Communicates verbally and in writing an accurate and comprehensive decision. Maintains performance at or above departmental metrics.

Principal Duties & Responsibilities

Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible

Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claims team operational metrics

Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimants and employers trust and confidence; anticipates customer's needs and takes action as appropriate

Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence

Performs other duties as required

Education & Experience Required

Bachelor's Degree In healthcare or a related field

1-2 years of STD Industry claims experience

Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services

Or an equivalent combination of education and experience

Job Knowledge & Skills