Case Manager (LTD/IDI Claims)

Scope:

The Long-Term Disability (LTD) Claims Consultant is responsible for evaluating and administering long-term disability insurance claims in accordance with policy provisions, regulatory requirements, and established service-level standards. This role requires strong analytical and decision-making abilities to assess claim eligibility, interpret medical and vocational information, and make accurate claim determinations. The consultant exercises independent judgment, demonstrates excellent customer service, communicates effectively with claimants and stakeholders, and manages a high-volume caseload while ensuring timely and compliant claim processing.

Key Responsibilities:

• Manage a caseload of moderately complex Long-Term Disability (LTD) claims, including new, ongoing, and appeal cases, while meeting productivity and quality standards.
• Evaluate claims and make accurate, timely decisions in accordance with policy provisions, regulatory requirements, and service-level expectations.
• Communicate with claimants, representatives, healthcare providers, attorneys, and other stakeholders to obtain and verify claim-related information.
• Review medical, vocational, financial, and occupational documentation to determine claim eligibility and identify additional information when needed.
• Maintain thorough, accurate claim documentation and prepare professional written correspondence regarding claim status and decisions.
• Collaborate with internal teams and external experts to support comprehensive claim evaluations.
• Resolve discrepancies, identify potential fraud concerns, and escalate issues when appropriate.
• Calculate disability benefits, including applicable offsets and return-to-work adjustments.
• Handle escalated customer inquiries and complaints with professionalism, ensuring timely resolution or referral to the appropriate team.

Requirements:

• 3+ years of experience handling Long-Term Disability (LTD) or Individual Disability Insurance (IDI) claims.
• Proven ability to make independent claim decisions based on available facts and policy guidelines.
• Strong analytical, critical thinking, and problem-solving skills.
• Excellent verbal and written communication skills with a customer-focused approach.
• Ability to assess complex situations, manage risk, and make sound decisions.
• Strong organizational, time management, and multitasking skills.
• Bachelor's degree or equivalent combination of education and relevant experience.