• Job Description

  Req#: 11017

  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

• About the company

  Providing healthcare, pension, financial and social services, training, child care and more to 1199SEIU members. Contact us at (646) 473-9200.

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