Senior Disability Claims Examiner – LTD
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Job Description
Senior Disability Claims Examiner providing exceptional service in managing Long-Term Disability claims at Prudential. Collaborating with medical resources and delivering exceptional customer experience.
Responsibilities:
- Provide excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims
- Utilize judgment and assess risk as you work with various business partners to render claim decisions
- Partner with medical and vocational resources to evaluate disability and support return to work goals
- Deliver an exceptional customer experience that serves to differentiate Prudential from competitors
- Communicate via telephone, email, and text with employees, employers, attorneys, and others
- Review and interpret medical records, utilizing resources as appropriate
- Complete financial calculations
- Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered
- Apply contract/policy provisions to ensure accurate eligibility and liability decisions
- Verify on-going liability and develop strategies for return-to-work opportunities as appropriate
- Document objective, clear and technical rationale for all claim determinations
- Leverage a broad spectrum of resources, materials, and tools to render claims decisions
- Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
- Provide technical direction and/or mentorship to other claims personnel as needed
Requirements:
- 4+ years of experience in Long Term Disability Claim Management required
- Exceptional customer service skills
- Ability to solve complex claim scenarios with minimal mentorship
- Excellent claim/risk management skills and technical knowledge in contract interpretation and administration
- Proven skills in positive and effective interaction with challenging customers
- Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English)
- Excellent organizational and time management skills with ability to multitask and prioritize deadlines
- Detail oriented; able to analyze and research contract information
- Demonstrated ability to operate with a sense of urgency
- Experience in effectively meeting/exceeding individual professional expectations and team goals
- Demonstrated analytical and math skills
- Ability to exercise critical thinking skills, risk management skills and sound judgment
- Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment
- Continuous improvement mindset
- A commitment to support a work environment that fosters Diversity and Inclusion
- Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.
Benefits:
- Medical, dental, vision, life insurance, disability insurance
- Paid Time Off (PTO)
- Leave of absences, such as parental and military leave
- 401(k) plan with company match (up to 4%)
- Company-funded pension plan
- Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs
- Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development
- Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs
- Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service
- Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance.
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