LTD Claims Examiner II: Complex Case Adjudication

Vets Hired; South Portland (ME); Sur place; USD 60 000 - 80 000; Plein temps

Résumé du poste

Vets Hired is seeking a qualified LTD Claims Examiner II to manage and adjudicate disability claims in accordance with policy provisions. The role involves reviewing medical and employment information, calculating benefits, and maintaining accurate records while handling a caseload of 60–80 claims.

The ideal candidate will have at least 2 years of disability claims experience, strong analytical and communication skills, and the ability to work independently within approved authority limits.

Qualifications

• Minimum two years of experience processing long-term disability claims.
• Understanding of claims management, analysis, and investigation techniques.
• Experience handling confidential information and knowledge of medical terminology.
• Strong math and benefit-calculation skills and ability to manage complex claims.

Responsabilités

• Investigate disability claims by gathering information from claimants, employers, physicians, and other parties.
• Analyze claim documentation and make fair eligibility and payment decisions per policy and regulations.
• Manage a high volume of claims ranging from simple to complex.
• Determine eligibility for waiver of premium benefits under life insurance policies.
• Calculate disability benefits, including partial/ residual disability, survivor benefits, and offsets.
• Review complex claims within established approval authority limits.
• Maintain accurate electronic claim data and documentation.
• Provide timely, respectful customer service while balancing priorities.

Connaissances

Disability claims processing

Analytical reasoning

Investigation techniques

Customer service

Formation

High school diploma or GED

Associate degree in related field

LOMA Level I designation

Description du poste

Vets Hired is seeking a qualified LTD Claims Examiner II to manage and adjudicate disability claims in accordance with policy provisions. The role involves reviewing medical and employment information, calculating benefits, and maintaining accurate records while handling a caseload of 60–80 claims.

The ideal candidate will have at least 2 years of disability claims experience, strong analytical and communication skills, and the ability to work independently within approved authority limits.