Disability Processor VI

Description

Responsibilities

• Evaluate and make appropriate determinations of disability claims in accordance with applicable state laws (NY and NJ) and Fund procedures
• Request required disability claim information from 1199SEIU members, physicians and employers to process new and ongoing disability claims
• Analyze and evaluate medical and vocational information to determine a member’s inability to work and to assist in return-to-work efforts while member is disabled
• Calculate accurate weekly or bi-weekly benefits based on the provisions of the Summary Plan Description (SPD) and earnings information received from employers; recalculate benefits as needed in situations where employer information was not received on time; assist with disability check releases
• Communicate with members, physicians, employers and other professionals via telephone and in writing regarding disability claim payments; provide excellent customer service to members to ensure disability claims are paid in a timely and accurate manner
• Produce manual hand checks for adjustments of rates, including sick days, first day paid and last day paid
• Complete in-depth interview with members to determine eligibility for worker’s compensation
• Refer disability claims to the appropriate support services which include medical consultants for review, Member Assistance Program (MAP) and refer members for independent medical examinations
• Process all claims assigned within the appropriate error ratios.
• Perform additional duties and projects as assigned by management
• Must meet performance standards including attendance and punctuality

Qualifications

• High School Diploma or GED required, some College or Degree preferred
• ·        Minimum two (2) years experience examining and resolving health claims in a health insurance or benefits environment; or (2) years experience reviewing or analyzing Disability Claims required
• Knowledge of disability claims systems, Current Procedural Terminology (CPT) codes, hospital claims history and International Classification of Diseases (ICD-9) codes required
• Demonstrated knowledge of New York State, New Jersey State disability laws and appropriate benefits from other sources (i.e. worker’s compensation) for offsetting benefits preferred
• Ability to evaluate and make determinations on new disability claims and manage continuous claims
• Basic knowledge of Microsoft Excel and Word preferred
• Excellent oral and written communication skills; ability to initiate and create written correspondence
• Ability to maintain a professional manner and attire at all times; ability to maintain a pleasant attitude to ensure excellent service to members
• Able to multi-task, establish priorities, meet deadlines, and follow through on assignments
• Able to handle heavy telephone call volume

We offer extraordinary benefits including outstanding health, dental, pension and family benefits for most positions which are paid entirely by the Funds without co-payments, deductibles, or out-of-pocket expenses for covered services. We also offer tuition reimbursement, generous holiday, vacation, and sick leave, as well as a 401K plan.