- Makes independent decisions in managing assigned caseload (up to 85) depending on the complexity of claims and business needs.
- Assists UL with workload balancing and work prioritization.
- Independently assess, analyze and render appropriate claim decisions, consistent with the applicable plans and federal and state law, to maintain appropriate and timely claim outcomes.
- Possesses and exercise the autonomy to take steps outside of CMG guidelines when supported by documented rationale and the facts of the claim file.
- Articulates and documents their rationale for claim direction.
- Acts as individual, team and office resource for claim related and technical issues.
- Participates in new hire onboarding as well as one on one coaching, mentoring and development.
- Serves as an extended leadership team member, providing direct support to Unit Leaders, and partners with leadership team to meet project goals related to quality, timeliness, and customer service and staff development.
- Reviews claim blocks, reports and data to track and analyze information against established claims metrics on standard and customized levels. Identifies best practices and opportunities. Works with leadership team to increase individual, team and organizational capabilities.
- Proactively mitigates risk by identifying trends within claim blocks, and offering feedback and solutions to improve overall performance.
- Provides feedback to leadership team on individual, team, customer or site performance. Responsible for identifying internal and external industry trends and International Claim Association (ICA) site lead.
- Partner with cross functional areas (LIFT, Account Team etc.) to provide subject matter expertise in the following areas: Overall Claims Management, Technical Skills, Communication, Work Prioritization, CDM Execution, and Return to Work focus.
- Performsother related duties as assigned orrequired.
Essential Business Experience and Technical Skills:
- High School Diploma; 10+ years of STD/LTD/IDI claimsexperience
- Knowledge of data collection, analysis and reporting techniques
- May require specialized knowledge acquired through formal claim training
- Bachelor’s Degreepreferred