Hybrid Disability Case Manager

at Alight Solutions

• Job title: Disability Case Manager
• Job type: Full Time
• Experience level: Junior, Mid level
• Salary: $65,000 - $90,000 per year
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Jersey City, United States

About the role

• Disability Case Manager managing Group Short Term Disability claims within Alight Solutions. Utilizes regulatory standards to administer claims and assess options for claimants.

Responsibilities

• Administering and case managing assigned Group Short Term Disability claims.
• Following the plan provisions, state and federal guidelines, and established protocols.
• Using most efficient and effective means of proactive outreach to obtain and/or dispense information.
• Communicating claim status and decisions via telephone and in writing.
• Initiating communications to claimant, physician, and/or plan holder to obtain information, make assessment, and initial claim decision.
• Prioritizing and reviewing new claims to adhere to established departmental productivity.
• Meeting productivity requirements as established by department for handling “fast track” disability claims with limited durations.
• Investigating and analyzing claim information to determine coverage and benefit eligibility.
• Performing pre-existing condition investigation and draft adverse determination letter, if applicable.
• Determining disability by comparing functionality with job.
• Setting up claim for initial benefit approval including physician statement(s) and medical records.
• Following claim management procedures and identifies potential return to work, job accommodation opportunities when applicable.
• Utilizing claim management resources, i.e. MDA (Medical Disability Advisor) and other disability guidelines.
• Working with the goal of returning claimant to active work status.
• Assessing claim when other sources of income are received to ensure accurate offsets are applied.
• Recalculating benefits as needed determining under/overpayments.

Requirements

• 4-year college education or equivalent work/education experience.
• Experience of 2 years of disability claim management experience (STD), or other previous Group insurance experience.
• Experience with candidate regulatory and compliance standards.
• Demonstrate independent problem solving and decision-making ability.
• Able to clearly communicate claim decisions and contract language verbally and in written correspondence.
• Demonstrate math aptitude, ability to multitask, and analytical skills.

Benefits

• Health, dental and vision coverages starting Day One.
• Wellbeing programs.
• Retirement plans with contribution matching.
• Generous time off.
• Parental leave.
• Continuing education.
• Career growth opportunities.
• Flexible working arrangements.