Disability Claims Examiner III
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Disability Claims Examiner III examines and adjudicates short- and long-term disability claims to determine eligibility, benefits, and ongoing entitlement under plan provisions. Reviews medical documentation, occupational information, and financial records to evaluate the validity of claims. Being a Disability Claims Examiner III assesses plan definitions, regulatory guidelines, and clinical guidance to make accurate benefit determinations. Coordinates with claimants, physicians, and vocational or clinical resources to obtain and assess relevant information. Additionally, Disability Claims Examiner III calculates benefit amounts, manages offsets, and documents decisions and rationale within the claims system. Ensures compliance with ERISA, state regulations, and company service standards. Requires a bachelor's degree. Typically reports to a manager. The Disability Claims Examiner III work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. To be a Disability Claims Examiner III typically requires 4-7 years of related experience.
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