Manager, Claims
On-siteWhite Plains, New York, United States
Job Summary
Review medical records, policy guidelines, and financial information to assess claim validity and determine financial liability. Collaborate with healthcare providers, vocational experts, and employers to verify diagnoses, treatment plans, and return-to-work status. Act as the primary point of contact for claimants, providing status updates and addressing inquiries while ensuring compliance with legal regulations and company policies. Identify potential fraud and resolve disputes through the Appeals Department and state regulatory agencies. Implement best practices to enhance claims processing efficiency. Requires a degree in insurance or healthcare, extensive claims experience, and familiarity with disability claims processing systems.
Required Qualifications
- A degree in insurance, healthcare, or a related field
- extensive work experience handling and processing disability claims
- The ability to analyze complex information from various sources, including contract terms, conditions, limitations and exclusions
- A deep understanding of insurance policies, medical terminology, and relevant regulations (i.e., disability laws)
- Both written and verbal communication, including empathetic listening and a high level of customer service
- Meticulous attention to detail
- Familiarity with the software and systems used for disability claims processing
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.