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Team Lead- Medical summarization
2 weeks ago
Greetings from Adecco..
Hiring for Long Term Disability Claim Manager
What You'll Do:
- Proactively manage your block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block
- Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpoint
- Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
- Leverage claim dashboard to manage claim inventory to find which claims to focus efforts on for maximum impact
- Have discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Ask focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Execute on all client performance guarantees
- Respond to all communications within customer service protocols in a clear, concise and timely manner
- Make fair, accurate, timely, and quality claim decisions
- Adhere to standard timeframes for processing mail, tasks and outliers
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated
- Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Clearly articulate claim decisions both verbally and in written communications
- Understand Corporate Compliance, Policies and Procedures and best practices
- Stay abreast of ongoing trainings associated with role and business unit objectives
What You'll Bring:
- High School Diploma or GED required. Bachelor's degree strongly preferred.
- Long Term Disability Claims experience preferred.
- Experience in hospital administration, medical office management, financial services and/ or business operations is a (+)
- Comfortable talking with customers and having thorough phone conversations.
- Excellent organizational and time management skills.
- Strong critical thinker.
- Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
- Ability to focus and excel at quality production
- Proficiency with MS Office applications is required (Word, Outlook, Excel).
- Strong written and verbal skills demonstrated in previous work experience.
- Specific experience with collaborative negotiations.
- Proven skills in positive and effective interaction with customers.
- Experience in effectively meeting/exceeding personal professional expectations and team goals.
- Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset.
- Comfortable giving and receiving feedback.
- Flexible to change.
- Demonstrated analytical and math skills.
Critical Competencies:
- Decision Quality
- Communicate Effectively
- Action Oriented
- Manages Ambiguity
- Customer Focus
.
