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Location: Omaha, NE; Kansas City, KS; Pittsburgh, PA; Minneapolis, MN; Dallas, TX; Los Angeles, CA; Hartford, CT; Allentown/Bethlehem, PA; Boston, MA; Atlanta, GA; Syracuse, NY; Chicago, IL
Job Title: Senior Disability Claims Examiner, Virtual
This is a Virtual work from home opportunity anywhere in the US. Initial Training will also be Virtual.
The goal of the Senior Disability Claim Examiner is to efficiently and effectively direct Long Term Disability claims toward the appropriate outcome while providing superior customer service. The Senior Disability Claim Examiner is a multi-dimensional position whose responsibilities include, but are not limited to:
- Heavy written and verbal communication with a diverse population of customers, including claimants with physical and mental impairments, physicians, attorneys, benefit representatives, other healthcare providers, and internal/external clients.
- Facilitate the technical aspects of the claim and appropriately apply the legal and contractual
- Ability to understand and interpret, financial, vocational, and medical information and opinions in relation to contractual benefits.
- Facilitate use of multiple resources that may be applicable to claim management, medical, vocational, and investigative tools.
- Calculate appropriate dates and payments amounts accurately.
- Develop and maintain effective working relationships with group clients.
- Lead/participate in projects/activities related to claim management and staff development.
- Understand and correctly utilize the appropriate systems.
- Ability to manage multiple and changing priorities.
- Excellent organizational and time management skills.
- Strong written and verbal communication skills demonstrated in previous work experience.
- Specific experience with collaborative negotiations.
- Proven skills in positive and effective interaction with customers.
- Experience in effectively meeting/exceeding individual professional expectations and team goals.
- Demonstrated analytical and math skills.
- Ability to exercise sound judgment.
- High level of flexibility to adapt to the needs of the organization.
- PC skills required (i.e., Windows based environment)
- College degree preferred.
- Incumbents typically have 5+ years of relevant experience managing Long Term Disability claims
Please visit our website, www.Prudential.com, search careers, select "search jobs", enter job number DMS0008F.
Location: Bloomfield, CT
Job Title: Vocational Rehabilitation Consultant
The MetLife Disability Claims group located in Bloomfield, CT is seeking a Vocational Rehabilitation Consultant.
Selected candidate will determine appropriate return-to-work potential and employment options consistent with long-term disability insurance claimant's education, transferable skills, interests, and residual functional capacity levels. Develops and facilities return-to-work and rehabilitation plans. Supports claim operations by providing vocational rehabilitation assessment and case management services, thereby impacting lengths of disability and facilitating timely returns to work.
- Clarifies claimant's employment history and residual functional capacity to assess return-to-work potential.
- Coordinates and negotiates with employer, employee, and treatment providers to promote safe and early return to work.
- Ensures early identification of disability rehabilitation candidates and develops appropriate rehabilitation plans using the return-to-work hierarchy.
- Provides return-to-work solutions through job modifications and accommodations. Assists claims staff by providing vocational opinions at various points throughout the claims administration process.
- Assists in identifying and monitoring services of health care facilities, rehabilitation facilities, job placement services, vendors, and state agencies to ensure compliance with agreed upon fees, services, quality, and timeliness standards.
- Participates in customer service presentations as needed; may work with employers to develop or enhance existing return-to-work programs.
- Performs other related duties as assigned or required.
- Master's degree in Vocational Rehabilitation. .
- 3-5 years of vocational rehabilitation experience.
- Certified Rehabilitation Counselor (CRC), or Certification of Disability Management Specialist (CDMS) designation.
- LTD/STD insurance experience preferred.
- Knowledgeable in the areas of physical and psychiatric diagnosis.
- Proficient with Microsoft Office Tools.
- Excellent Verbal & written communication skills.
Please visit the MetLife website (www.metlife.com), select the “Careers” tab to view the job description and apply on-line. You can search for this posting by location, or Job Number (74692).
Location: Toronto, Ontario
Job Title: Senior Claims Adjudicator
Purpose of role
As a Member of the Claims team you will be accountable for ensuring that all claims are adjudicated and administered according to state and provincial law and regulation and in a fair, ethical and efficient manner.
- Adjudicate various types of complex claims including Life, Critical Illness, Terminal Illness and Disability. This includes identifying, collecting and reviewing all relevant information needed to determine the claim ligitimacy and eligibility as well as the benefit amount payable.
- Request and review the requirements of the appropriate provincial/state legislation and regulations related to the type of claim being reviewed.
- Perform all necessary benefit calculations and ensure all related activities are in compliance with provincial/state statutory and internal standards.
- Determine outside resources needed to evaluate claims and be able to communicate effectively with such outside resources such as medical consultants, legal consultants, independent physicians, coroners, police or investigative services.
- Determine which claims need to be referred for evaluation and decision, based on authority limits, business case issues or referral to legal counsel.
- Maintain and update system records as necessary
- 5 – 7 years experience adjudicating complex claims, including contestable
- Knowledge of claims adjudication theory, principles, methods, systems, processes and standards including an understanding of insurance medicine and actuarial principles/methods as they relate to the claims function.
- Knowledge of the interpretation and application of claims adjudication regulations across Canada and the US
- Self starter with demonstrated ability to prioritize case load and ability to research/problem solve and make decisions both independently and collaboratively within a fast paced team environment
- Advanced verbal and written communication skills to effectively communicate with internal and external customers/partners and vendors.
- Strong reasoning and judgment to balance commitments, financial soundness and quality customer focus
- Strong analytical skills for research, review and assessment of claims.
- ALHC designation an asset
- Bilingual (French or Spanish) an Asset
To pursue this opportunity, please email your covering letter and current resume, quoting reference # 45-13 to Talent@Foresters.com by September 30, 2013.
Location: Toronto, Ontario
Job Title: Manager, Claims
Purpose of Role:
As a member of the Insurance Operations, the Manager, Claims is accountable for achieving the required business results through effective team development and leadership. The Manager will ensure a consistent and exceptional service experience for internal & external customers by ensuring the employees are motivated, coached, developed and skilled to meet the department’s performance targets. The manager will have a view of operational efficiency with a focus on enhancing the customer experience and relationship with Foresters. The Manager will also play a lead and/or key role in the implementation of major change initiatives.
Our customer service approach will be achieved through our dedication to service, our focus on performance and our commitment to personal accountability.
To be successful in this role, you will:
- Display high energy, passion and a positive attitude
- Meet tight timelines under pressure while delivering quality service
- Own the results, share work experiences and willingly seek and accept personal accountability
- Continuously learn about customers and internal service partners, regarding their priorities and their expectations
- Support Foresters’ key enterprise priorities
- Develops people, including coaching all team members effectively, recognizing and rewarding progress, encouraging and modeling continuous learning and development.
- Assessing teams’ adjudication skills and elevating expertise to full competency in all required functions and company-approved technologies and tools.
- Demonstrated ability to understand the vision of the department and translate it into action and incorporate into the day-to-day operations by ensuring that service and quality objectives are being attained and maintained on a consistent basis.
- Understanding group dynamics, building strong, productive and cohesive teams, demonstrating collaboration and mutual problem solving, and providing leadership opportunities for team members.
- Responsible to align sales objectives with operations objectives and corporate objectives of fair claims practices
- Collaborate with other leaders, including Insurance Operations Leadership Team (IOLT) to ensure that all functions are fully integrated and are in accordance with the Company's goals and objectives, ensuring that all overarching SLA's are met and/or exceeded.
- Effectively liaise and negotiate with other business units, including legal and underwriting to resolve and enhance customer service expectations and business deliverables.
- Plan and control department budget by anticipating future employee requirements, supplies and equipment, and improving department effectiveness while decreasing expenses whenever possible, including creation and management of capacity models.
- Monthly and Quarterly reporting of key claims metrics and trending
- Representing Foresters from a claims perspective during the course of litigation or regulatory hearing; including acting as a witness during such process, and participating in mediations and settlement conferences
- Responsible for working closely in conjunction with Reinsurers
- Attend industry meetings and develop national relationships and a network of industry contacts
- Assess, negotiate and resolve disputed claims based on their merits in a fair and cost effective manner according to state and provincial laws and regulations, and according to Foresters claims philosophy and Manual
- Minimum of 7-10 years of claims management experience including individual life claims adjudication (principles, methods, systems, processes and standards).
- Understanding of insurance medicine, and actuarial principles/methods as they relate to the claims function
- Thorough knowledge of the interpretation and application of claims adjudication, common law, legislation and regulations across Canada and the U.S.
- Strong people leadership skills with the proven ability to create and lead high performing teams.
- Change Management, including the ability to work in a new and ambiguous environment where tasks, processes, procedures, and lines of authority are evolving and changing.
- Financial Industry Products and Services, including a basic knowledge of their characteristics and suitability for different customer needs, keeping current with IOF products and services as partnerships develop and keeping up to date with general trends in the financial industry.
- Excellent problem solving and analytical skills to identify and report on team's progress, business trends, initiatives, customer and employee issues, including the ability to identify problems in their early stages and solve by analyzing options and developing alternative solutions.
- College Diploma or University Degree an asset
- Insurance designations (i.e. ALHC, FLMI, ACS) an asset
- French is also an asset
To pursue this opportunity, please email your covering letter and current resume, quoting reference 12-13 to Talent@Foresters.com
All postings will remain for 60 days unless otherwise noted
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