Disability Benefit Specialist
Under general supervision, the Associate Disability Benefits Specialist reviews, evaluates and processes disability insurance claims according to procedure and practice; handling assigned cases from claims receipt to benefit decision.
- As directed, receives claim assignment, confirms eligibility and directs acknowledgement of claims
- As directed, approves and determines benefits due to a disability plan
- Informs claimants of documentation required to process claim and time frames
- Interprets and makes decisions as directed on claims and eligibility requirements and determines if claimant meets the eligibility requirements
- After initial review of a claim, makes a decision if the claim needs additional medical, employment or educational documentation to confirm the presence or extent of a disability.
- Determines if claimants meet the eligibility requirements after investigating and evaluating the information provided
- Coordinates referral of claims to outside vendors
- Drafts detailed, personalized correspondence to inform claimants of their benefits or ineligibility based on the information provided from claim receipt
- Proactively identifies potential fraudulent activities or trends either at the claim level or enterprise level and takes necessary steps as directed to further investigation to ensure any claim approved is eligible on all levels
- Under supervision, medically manages claims ensuring compliance with guidelines, procedures and plan provisions.
- Upholds the Crawford Code of Conduct
- Bachelors degree or equivalent experience requires
- Aptitude for leaning medical terminology and conditions, as well as interpreting procedures and regulations
- Ability to work independently while assimilating various technical subjects
- Computer knowledge in excel, word, web based systems, etc
- Above average verbal and written communication skills
- Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
- Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action
- Strong ability to identify, analyze and solve problems
- Effective interpersonal skills capable of dealing with external sources and all levels of employees
- Experience working for a TPA or insurance carrier is desired
- Experience in a health or insurance or customer service related industry is desired
Think all TPAs are the same? Think again. With Broadspire, our leading global third-party administrator (TPA), Crawford & Company is the consultative outsourcing partner that adapts to businesses needs and challenges at any point of the claims processing journey. We offer casualty claim and medical management services to assist large organizations in achieving their unique goals, increasing employee productivity and reducing the cost of risk through professional expertise, technology and data analytics.
As part of the One Crawford family, Broadspire brings together the best and brightest people in the industry to deliver smart, thoughtful solutions to our clients, and we are guided by our collective value system: RESTORE.
At Crawford, we:
- Respect our culture of integrity and ethical behavior, while embracing the unique talents of the individual and encouraging an ownership mentality among everyone.
- Are Empowered to advance the company mission and take ownership of our individual career progression.
- Promote Sustainability through a corporate culture in which employees are good stewards of their communities.
- Emphasize Training and an environment where employees continually seek and share knowledge and are engaged and satisfied with their work.
- Are One Crawford, embracing a global mindset thats inclusive, agile, mission-focused, and customer-focused.
- Give Recognition, participating in an environment where people are rewarded for jobs well done.
- Embody an Entrepreneurial Spirit, sharing a passion to succeed, innovate, and outpace our competitors.
We believe in leading by example at work and in our communities. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in mission, vision and values. Learn more at www.crawfordandcompany.com.
In addition to a competitive salary, Crawford offers you:
- Career advancement potential locally, nationally and internationally. Crawford & Company has more than 700 locations in 70 countries
- On-going training opportunities through every stage of your career
- Strong benefits package including matching 401k; health, dental, and life insurance; employee stock purchase plans; tuition reimbursement and so much more.
Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.