Lead Benefit Claim Specialist (Workplace Solutions)

As a vital member of our LTD team, you will ensure the accurate, prompt and thorough evaluation and management of Disability claims by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry-leading customer experience.

This role requires a high level of independent decision making and critical thinking. Claims analysis includes but is not limited to: eligibility determination for both initial and ongoing benefits based on the medical information received, contract analysis, customer service, fraud detection and awareness, financial calculations, interpreting and analyzing medical and vocational information and adhering to all statutory/governmental regulations.

LTD Class starts on Monday, April 29, 2024. Training hours are 7:30-4:00 CST for up to 9 weeks.

WHAT WE CAN OFFER YOU:

• Estimated Annual Salary: $56,150 - $89,470, plus annual bonus opportunity.
• Benefits and Perks, 401(k) plan with a 2% company contribution and 6% company match.
• Regular associates working 40 hours a week can earn up to 15 days of vacation each year.
• Regular associates receive 11 paid holidays in 2024, which includes 2 floating holidays that are added to your prorated personal time to be used at your discretion.
• Regular associates are provided sick leave through the use of personal time. Associates working 40 hours a week can receive up to 40 hours of personal time in 2024, which is prorated based on the start date. Additionally you will receive two floating holidays in 2024 by way of personal time that may be used at your discretion.
• Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.

WHAT YOU'LL DO:

• Make sound/autonomous decisions throughout the life of the claim (initial adjudication and ongoing claims management) based upon claim facts, thorough evaluation and gathering pertinent information to formulate appropriate action plans.
• Develop files that demonstrates appropriate decision making based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
• Review and determine continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions and determining any change in status or benefits. Requires interaction and coordination with internal and external partners including but not limited to brokers, sales organization, clinical and physician resources, vocational experts, vendor partners and financial resources.
• An expert in the claims process and has accountability for the development of team members. This role is proactive in issue identification, mentoring and development plans for all Benefit Claim Specialists and Senior Benefit Claim Specialists. Assists with customer implementations and large case customer relationships. Is a leader and initiator of departmental projects, assists with the management of a team and is a back up to the Team Leader
• Supporting disability products is expected to manage a more complex and diverse caseload (i.e. concurrent LWOP, State Plans, Paid and Unpaid Leave).

WHAT YOU’LL BRING:

• Ability to interpret vocational and medical information to formulate claim decisions.
• Excellent analytical and decision-making skills.
• High Level of independent decision making and critical thinking capabilities.
• Strong organizational skills, attention to detail with a high degree of accuracy and the ability to work independently and apply a sense of urgency.
• Ability to adapt to a changing environment.
• You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
• Ability to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

PREFERRED:

• 4+ years of an STD or LTD case load.
• College degree or equivalent industry experience.

We value diverse experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!

If you have questions about your application or the hiring process, email our Talent Acquisition area at careers@mutualofomaha.com. Please allow at least one week from time of applying if you are checking on the status.

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