South Portland, ME
Industry: Accounting, Finance & Insurance•
5 - 7 years
Posted 111 days ago
To contribute to the overall success of Custom Disability Solutions objectives by providing timely and accurate support to our client companies and the Appeals unit of the Compliance Department. To meet all key risk management objectives and enhance customer service levels for Appeals team. To effectively monitor and mentor the performance of appeals staff in order to achieve optimal appeal outcomes and productivity in alignment with CDS’ philosophy. To effectively coach and mentor team members to ensure that high quality appeal management and legal risk mitigation services are performed. To assist in collecting data and providing feedback intended to promote quality enhancements in CDS claim and appeal processing.
CDS strives to ensure the independence and impartiality of all persons involved in making claim and appeal decisions. Accordingly, CDS’s decisions regarding hiring, compensation, termination, promotion, or other similar matters with respect to any individual are not made based upon the likelihood that the individual will support the denial of a benefit.
· Consistently adheres to the documented workflow guidelines and established procedures.
· Monitors receipt of new appeals and assigns new appeals in a manner to ensure relatively equitable distribution of work and to minimize backlog of appeals.
· Maintains appropriate appeals case load as directed by the manager.
· Addresses technical questions regarding contract interpretation and appeal decision(s).
· Provides review and signoff for specific appeal staff activities as designated by Compliance management to ensure appeal and DOI complaint response handling is done within established standards.
· Mentors and coaches appeals staff as part of and following release from training period. Documents proficiency levels of appeals staff. Communicates proficiency levels, performance feedback and training needs to Manager.
· Ensures appeal determinations are released/authorized as needed.
· Maintains clear and ongoing communications with other business partners, inside and outside of appeals unit – Claims, QA, Training, Policy and Procedures, Underwriting, Legal, etc.
· Coordinates with Quality Review area to ensure that opportunities for quality enhancement arising from appeal file work are being maximized
· Provides periodic appeals activity reports to management.
· Assists manager with employee performance review process
· Other duties assigned by management to meet business needs.
· BA/BS or combination of related work experience and education.
· Minimum of five years of experience managing short term and/or long-term disability appeals.
· Previous mentoring experience.
· Previous management/supervisory experience preferred.
· Must be able to work independently, make sound judgments and be able to establish good working relationships internally and externally.
· Excellent written and oral communication skills.
· Excellent organizational and analytical skills.
· 2 or more professional designations preferred.
· NY Independent Adjuster license preferred
Job Requisition ID: EM12140