Disability Claims Examiner

IMRF; Oak Brook (IL); Hybrid; USD 53,000 - 57,000; Full time

Benefits offered by this job

Pension benefits

Medical and dental insurance

35-hour work week

One remote day per week after 1 year

Paid vacation and holidays

Job summary

IMRF is seeking a Disability Benefits Examiner to review applications and supporting documents, input data into the claim processing system, and determine eligibility for disability benefits. This role involves complex and routine processing with Senior staff support as needed, and regular communication with members, employers, physicians, and other stakeholders.

The position emphasizes accuracy, timely follow-ups, and the ability to handle confidential medical information, with some remote work

Qualifications

• Associate degree or two years related experience and/or on-the-job training.
• Ability to read, analyze and interpret benefit claim forms, supporting medical documents, and written procedures.
• Ability to write business correspondence and effectively communicate with internal and external customers.
• Ability to apply concepts of wage and service information and IMRF benefit formulas.

Responsibilities

• Review and input information from IMRF forms and supporting documentation.
• Obtain information from employers, physicians, hospitals, and other sources to determine eligibility.
• Determine eligibility and duration for temporary, total, and permanent disability benefits.
• Approve temporary disability benefits and advise on Total and Permanent disability.
• Write letters summarizing medical and non-medical facts of disability cases.
• Maintain follow-up dates and service level targets for each ongoing claim.

Skills

Customer service

Disability benefits knowledge

Analytical skills

Communication skills

Education

Associate degree

Two years related experience

Job description

This position is responsible for reviewing applications, and supporting documents, for disability benefits, and inputting the correct information into the claim processing system to begin the processing of disability benefits. This position is responsible for using manual processing procedures to resolve most pending conditions. It is expected that this position can independently process all but the most complex temporary and total and permanent disability claims. Direct support will be given on complex disability claims involving trial work, outside wages, workers’ compensation, and T&P initial and subsequent approvals by a Senior Claims Examiner or Analyst. Second level approval is needed by a Senior Claims Examiner or higher for T&P approvals, other manually approved claims, and pre-determined automated claims.

This position provides customer service for members who are applying for, or already approved for, or are being considered for continuing eligibility for disability benefits.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Review and accurately input all information from all IMRF forms and supporting documentation submitted by IMRF members.
• Contact other IMRF departments to obtain information and request corrections in an effort to resolve most internal conditions preventing payment of benefits.
• Contact employers, employees, physicians, hospitals, Social Security and worker’s compensation carriers to obtain information necessary to determine eligibility, duration and amount of most disability benefits.
• Review medical records to determine extent of disability for temporary / total and permanent claims, and to make recommendations concerning the application of pre-existing condition language.
• Approve members for temporary disability benefits and make recommendations concerning member’s eligibility for Total and Permanent disability.
• Provide customer service to employers, employees, medical providers, and other IMRF departments by answering questions concerning procedures and benefits, either in writing or by telephone.
• Maintain a work in progress that meets the service goals established by the Disability Manager.
• Provide detailed information to vested members concerning retirement benefits, including a comparison between IMRF benefits available to disabled members and benefits available to retired members. This requires the examiner to do a service audit.
• Analyze the initial claim application and supporting documents to determine what additional requests for information must be made to obtain the necessary level of documentation to approve or deny the application for disability benefits.
• Establish follow-up dates and methods for each on-going claim assigned to them.
• Write letters to the IMRF medical consultants that summarize the medical and non-medical facts of disability cases.

Other duties may be assigned.

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

Associate degree or two years related experience and/or on-the job training; or equivalent combination of education and experience equaling two years.

LANGUAGE SKILLS

Ability to read, analyze and interpret benefit claim forms, supporting medical documents, and written procedures. Ability to write business correspondence. Ability to effectively communicate with both internal and external customers to respond to questions and obtain information.

MATHEMATICAL SKILLS

Ability to work with mathematical concepts such as benefit calculations, including use of the IMRF benefits formulas, and wage and service information. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

REASONING ABILITY

Ability to analyze/solve practical problems and deal with a variety of concrete variables in situations where standard procedures and calculations normally exist. Ability to analyze/interpret medical history and documents to determine when additional investigation is necessary, and to determine the extent of disability. Ability to conduct an organized investigations and follow-ups.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to walk. Specific vision abilities required by this job include close vision.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

ADDITIONAL INFORMATION

This position requires a person who is detail orientated and has strong customer skills. This position requires a well-organized person who can maintain a professional demeanor when working with a variety of confidential medical issues. The ability to review / analyze medical documents to discover information key to making benefit decisions is a must.

BENEFITS AND SALARY

The expected annual salary range for this role is $53,369-$56,571. Please note the salary information is a general guideline only. Salaries are based upon candidate skills, experience, and qualifications, as well as market and business considerations. The range listed is just one component of IMRF's total compensation package for employees.

Other factors include the following benefits:

• Pension, death, and disability benefits as a member of IMRF
• Generous insurance benefits, including medical and dental
• 35-hour base work week, Monday-Friday. Ability to work one day remote, per week, after 1 year of hire.
• Paid vacation, paid sick, 12-13 paid holidays and 2 personal days