Disability Case Manager Senior

Title: Disability Case Manager Senior

Disability Case Mgr Sr is responsible for investigating and documenting Short Term Disability (STD) or Long Term Disability (LTD) claims for group policyholders.

Primary duties may include, but are not limited to:

• Administers disability income payments on behalf of group policyholders.
• Gathers clinical and eligibility information to verify approved period of disability.
• Reviews claim materials against STD or LTD disability policy coverage as well as duration guidelines.
• Determines liability and adjudicates the claim.
• Works with Disability Management nurses, and Physician Reviewers to review complex/questionable claims.
• Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
• Reviews ongoing disability claims to determine continued liability for the company.
• Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering.
• Handles escalated cases.
• Provides testimony involved in depositions in contested claims.
• Administers payments on a monthly and weekly basis.
• Performs calculations for adjustments for Social Security and Workers Compensation awards.
• Mails appropriate State program forms to employees.
• Performs audits of STD/LTD claims; provides coaching, mentoring and feedback as directed by manager.

  Requirements:

  • BA/BS degree
  • 3 years of Disability Case management
  • Minimum of 3 years experience in customer service or insurance claims, preferably in the managed care or insurance sectors, or any combination of education and experience which would provide an equivalent background.

    For URAC-accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

    For candidates working in person or remotely in the below locations, the salary* range for this specific position is $ 26.78 /hr to $48.22/hr

    Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY

    In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

    * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
    

Salary : $48