Short Term Disability Claims Manager
As a Short Term Disability (STD) Claims Manager, you will develop the knowledge and skills needed to conduct thorough investigations, make determinations regarding short-term disability eligibility for our customers, provide ongoing claim administration, and communicate decisions and status updates. This is a fast-paced job where attention to detail counts. The Claim Manager’s decisions have a direct impact on customers’ health, well-being and sense of security. The ability to make and effectively communicate decisions within tight timeframes, while integrating knowledge of medical conditions, customer contracts, Cigna Group Operations and corporate compliance are critical for success.As a Disability Claims Manager, you will:
- Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources.
- Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Pay all covered claims accurately and timely
- Execute on all customer performance guarantees
- Adhere to standard timeframes for processing mail, tasks and outliers
- Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
- Stay abreast of ongoing trainings associated with role and business unit objectives
- Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
Qualifications:
- 1 year minimum of professional experience strongly preferred
- HS Diploma or GED required. Bachelor’s degree strongly preferred.
- Proficiency with MS Office applications is required (Word, Outlook)
- Proven track record of successfully driving results in a complex matrix environment is a (+)
- Strong critical, analytical and investigative skills; ability to gather information, analyze facts, and draw conclusions
- Additional experience administering FMLA and/or State Leaves is a (+).
- Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
- Ability to build and maintain effective relationships
- Effective interpersonal, written and verbal communication skills
- Excellent planning, time management and organizational skills
- Ability to manage multiple and changing priorities.
- Strong negotiation skills
- Knowledge of legal liability, insurance coverage and medical terminology is a (+)
- Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
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