The Nurse Specialist reports to the disability case manager and is responsible for managing short term disability claims for contracted clients from intake through approval for payment, continued monitoring of open claims and clerical functions to support these services.
Main Duties and Responsibilities:
- Access claims submissions via fax and email, review for required information in compliance with client policies, accurate data entry, and communicate to client representative for payment
- Making decisions for approval or denial of claims using contractual, medical, and vocational analysis
- Maintain productive relationships with internal advocates, client employees and benefits representatives, and medical professionals
- Respond in timely manner to high volumes of written (fax and email) and verbal (primarily telephone) communication with a wide range clients’ employee, client representatives, medical professionals in multiple communities
- Continual prioritization of conflicting demands with rapid response and efficient resolution.
- Frequent communication with internal team members
- Ensure a high level of client satisfaction, meeting weekly reporting requirements and quick turnaround times for claims processing
- Assume the daily functions for the Disability Claims Manger when absent, whether planned or unexpected