Hi,
My name is Rohit Chauhan, and I am a Staffing Specialist at Novia Infotech LLC. I am reaching out to you on an exciting job opportunity with one of our clients.
Job Title: Disability Claims Specialist
Location:
Cincinnati, OH / Remote
Domain: Insurance – Disability
Claims
Role Overview
We are seeking a detail-oriented and analytical Short Term Disability Case Associate to manage disability claims and ensure accurate adjudication based on medical documentation and policy guidelines. The ideal candidate will have strong experience in disability claims processing, case management, and stakeholder communication within the insurance domain.
Key Responsibilities
- Manage end-to-end short-term disability claims, including intake, review, adjudication, and closure.
- Analyze medical documentation such as diagnostic tests, physician notes, and operative reports to determine eligibility based on plan definitions.
- Evaluate claims and determine benefits due, ensuring timely payments, approvals, and necessary adjustments.
- Conduct outreach to employees, physicians, and employers for missing or additional documentation.
- Utilize clinical guidelines and collaborate with in-house clinicians and vocational experts to assess disability duration and return-to-work opportunities.
- Handle claims related to Workers’ Compensation, State Disability, and other offsets.
- Communicate effectively with claimants and clients via phone and written correspondence to set clear expectations.
- Manage workload efficiently, ensuring adherence to service level agreements (SLAs) and timelines.
- Perform first-level escalation handling and support second-level escalations when required.
- Conduct peer reviews to ensure accuracy, compliance, and process adherence.
- Identify and recommend process improvements to enhance service delivery and operational efficiency.
- Participate in special projects and additional responsibilities as assigned by management.
Required Skills & Qualifications
- 4–6 years of experience in disability claims processing or case management.
- Strong knowledge of Short Term Disability (STD) policies and insurance claim adjudication.
- Experience analyzing medical records and clinical documentation.
- Familiarity with Workers’ Compensation and State Disability programs.
- Excellent analytical, decision-making, and problem-solving skills.
- Strong verbal and written communication skills.
- Ability to manage multiple claims and meet deadlines in a fast-paced environment.
- Proficiency in using claims management systems and MS Office tools.
Preferred (Nice-to-Have) Skills
- Experience working with clinical or vocational resources.
- Knowledge of disability duration guidelines and return-to-work programs.
- Prior experience in insurance or healthcare domain.
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Rohit Chauhan IT Recruiter A: 4421 Avenida Ln, McKinney, TX, 75070
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