1. What are the responsibilities of 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. 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. 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. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4-7 years of related experience.
2. What are the skills of Disability Claims Examiner III
Specify the abilities and skills that a person needs in order to carry out the specified job duties.
Each competency has five to ten behavioral assertions that can be observed,
each with a corresponding performance level (from one to five) that is required for a particular job.
1.)
Customer Service:
Customer service is the provision of service to customers before, during and after a purchase. The perception of success of such interactions is dependent on employees "who can adjust themselves to the personality of the guest". Customer service concerns the priority an organization assigns to customer service relative to components such as product innovation and pricing. In this sense, an organization that values good customer service may spend more money in training employees than the average organization or may proactively interview customers for feedback. From the point of view of an overall sales process engineering effort, customer service plays an important role in an organization's ability to generate income and revenue. From that perspective, customer service should be included as part of an overall approach to systematic improvement. One good customer service experience can change the entire perception a customer holds towards the organization.
2.)
Medical Management:
Medical management is an umbrella term that encompasses the use of IT for health, disease, care and case management functions. Designed to modify consumer and provider behavior to improve the quality and outcome of healthcare delivery.
3.)
Financial Services:
A services provided by the finance industry, which encompasses a broad range of businesses that manage money. These services involve banking, brokerage, mortgages, credit cards, payment services, real estate, investment funds, taxes and accounting.
