Disability Processor VI

Responsibilities

Evaluate and make appropriate determinations of disability claims in accordance with applicable state laws (NY and NJ) and Fund procedures

Request required disability claim information from 1199SEIU members, physicians and employers to process new and ongoing disability claims

Analyze and evaluate medical and vocational information to determine a member's inability to work and to assist in return-to-work efforts while member is disabled

Calculate accurate weekly or bi-weekly benefits based on the provisions of the Summary Plan Description (SPD) and earnings information received from employers; recalculate benefits as needed in situations where employer information was not received on time; assist with disability check releases

Communicate with members, physicians, employers and other professionals via telephone and in writing regarding disability claim payments; provide excellent customer service to members to ensure disability claims are paid in a timely and accurate manner

Produce manual hand checks for adjustments of rates, including sick days, first day paid and last day paid

Complete in-depth interview with members to determine eligibility for worker's compensation

Refer disability claims to the appropriate support services which include medical consultants for review, Member Assistance Program (MAP) and refer members for independent medical examinations

Process all claims assigned within the appropriate error ratios.

Perform additional duties and projects as assigned by management

Must meet performance standards including attendance and punctuality Qualifications

High School Diploma or GED required, some College or Degree preferred

Minimum two (2) years experience examining and resolving health claims in a health insurance or benefits environment; or (2) years experience reviewing or analyzing Disability Claims required

Knowledge of disability claims systems, Current Procedural Terminology (CPT) codes, hospital claims history and International Classification of Diseases (ICD-9) codes required

Demonstrated knowledge of New York State, New Jersey State disability laws and appropriate benefits from other sources (i.e. worker's compensation) for offsetting benefits preferred

Ability to evaluate and make determinations on new disability claims and manage continuous claims

Basic knowledge of Microsoft Excel and Word preferred

Excellent oral and written communication skills; ability to initiate and create written correspondence

Ability to maintain a professional manner and attire at all times; ability to maintain a pleasant attitude to ensure excellent service to members

Able to multi-task, establish priorities, meet deadlines, and follow through on assignments

Able to handle heavy telephone call volume