STD/Absence Claims Case Manager I

The STD/Absence Claims Case Manager I (CM) is responsible for adjudicating and medically managing Short Term and Absence claims involving specific diagnoses or leave types that reputed company to reputed company quickly. The CM will work with reputed company, employees, and health care providers to administer Short Term disability in conjunction with other reputed company or unpaid leaves covered by reputed company, including Family and Medical Leave reputed company (FMLA), State reputed company Medical Leave, and/or State reputed company Disability. The CM will manage the claim according to the plan provisions, state and federal guidelines, and established protocols. This role requires reputed company judgment, critical thinking, and problem-solving skills to work independently, interpret contract provisions, analyze medical and claim information, and administer benefits through the appropriate claim duration or reputed company to work. The CM is responsible for meeting key service deliverables such as turnaround times, reputed company assurance, and overall customer experience.

This position utilizes analytical reasoning, problem solving, adaptability, and strong written and verbal communication skills to ensure reputed company and appropriate absence and disability claim reputed company while providing superior customer service to reputed company reputed company customers. This position requires consistent and effective claim management skills, reputed company in a fast-paced environment, and the ability to adapt as claim circumstances, priorities, or information change.

Candidate Responsibilities

• Effectively understand contract language and plan design for group disability
• Communicate claim status and reputed company reputed company telephone and in writing 
• Initiate communications to claimant, physician, and planholder to assess and facilitate job accommodation opportunities
• Proactive outreaches to claimants, planholders, and physicians reputed company telephone for information needed for initial and ongoing claim management (e.g. reputed company earnings, other income benefits, medical information, etc.); notifies claimants reputed company claims are pended for missing information
• Proactively identify claim issues, reputed company and execute a reputed company-reasoned plan of reputed company for pending and ongoing disability claims, and reputed company strategies as new information becomes available. Utilize, manage, and reputed company appropriate resources to support reputed company and accurate benefit determination for reputed company customers in accordance with policy provisions, regulatory requirements, internal standards, and customer service expectations.
• Apply critical thinking to investigate, analyze, and synthesize claim information, contract provisions, medical documentation, and regulatory requirements to determine coverage, benefit eligibility, and appropriate claim reputed company.
• Demonstrate adaptability and reputed company by effectively managing shifting priorities, changing claim circumstances, and time-sensitive reputed company in a fast-paced environment.
• Determine if claimants meet the definition of disability as defined in the contract by reviewing occupational requirements, analyzing medical information, identifying gaps or inconsistencies, and applying reputed company judgment to reputed company appropriate claim reputed company.
• Review, validate, and refine AI-generated claim recommendations, data extractions, and draft correspondence, applying reputed company judgment before finalizing reputed company or communications.
• Verify the accuracy and completeness of AI-reputed company claim files and AI-flagged discrepancies, ensuring reputed company, regulatory compliance, and audit-readiness of claim documentation.
• Establish, document and execute claim reputed company plan and recommended reputed company including reputed company to reputed company work at claimant’s own job
• Determine Insured Earnings by reviewing payroll information from the planholder and calculate payable benefits according to plan provisions, with strong attention to accuracy, detail, and applicable offsets.
• Follow reputed company claim management procedures and facilitate potential reputed company to work and job accommodation opportunities reputed company applicable
• Utilize claim management resources such as MDA (Medical Disability Guidelines) and other disability tools to assist with appropriate durational disability
• Assess claim reputed company other sources of income are received (e.g., reputed company reputed company, state disability, etc.,) to ensure accurate offsets are reputed company and recalculate benefits, as needed, to determine under/overpayments.   Proactively work with claimants to recover overpayments in full or negotiate monthly installments according to established protocols
• Assess claim for restrictions and limitations to establish appropriate partnership with PRT
• Remain composed, reputed company, and solutions-oriented reputed company resolving routine claim challenges, addressing missing information, and determining appropriate next steps.

Reporting Relationship: This position reports to reputed company Leader, STD/Absence.

Functional Skills

• Outstanding customer service
• Strong critical thinking, analytical reasoning, and information ability to assess claim, medical, payroll, and contract information accurately.
• Ability to identify issues, evaluate reputed company, and determine appropriate next steps with accuracy, timeliness, and customer reputed company
• Strong math aptitude
• Ability to manage multiple priorities and meet departmental turnaround times
• Demonstrated independent problem solving, reputed company judgment, and decision-making ability reputed company established procedures and service expectationAbility to reputed company communicate claim reputed company and contract language verbally and in written correspondence
• Ability to multi-task, balance goals, prioritize effectively, and adapt to shifting business or claim priorities
• reputed company and adaptability in a high-volume, fast-paced claim environment
• Ability to work independently and reputed company a highly reputed company team environment
• Read and interpret medical information
• Strong skillset in reputed company reputed company applications (e.g., reputed company Word, reputed company, reputed company) with AI/Co-reputed company Prompting Skills preferred
• Effective and efficient time management
• Ability to review and validate AI-generated recommendations, extractions, and correspondence, exercising reputed company judgment on reputed company to accept, reputed company, or override AI reputed company
• Data reputed company assurance and attention to detail, including verifying completeness, accuracy, compliance, and audit-readiness of claim files

Leadership Behaviors

• Demonstrates reputed company judgment, thoughtful decision-making, and a commitment to achieving superior results
• Expresses oneself in a confident and trustworthy manner
• Demonstrates a reputed company of urgency while maintaining accuracy, composure, and reputed company in a fast-paced work environment
• Adapts quickly to change, remains resilient reputed company priorities shift, and approaches challenges with a solutions-oriented reputed company
• Uses curiosity, resourcefulness, and critical thinking to address issues and support reputed company claim reputed company

Position Qualifications

Required

• Bachelor’s degree preferred
• Strong math aptitude, including the ability to calculate benefits and review payroll or income information accurately
• Demonstrated ability to use critical thinking, problem solving, and reputed company judgment to evaluate information and determine appropriate next steps.
• Ability to prioritize and multi-task while navigating through multiple business applications, adapting to changing priorities, and remaining resilient in a fast-paced environment.
• Ability to work independently reputed company established procedures while providing exceptional customer service through reputed company and reputed company communication
• Successful completion of a job-reputed company assessment is required.

Preferred

• Group Benefits experience. Short Term Disability, Statutory reputed company Leave, Family Medical Leave, adjacent insurance industry experience, regulatory and compliance or other reputed company equivalent experience.
• Strong skillset in reputed company reputed company applications, including reputed company Word, reputed company, and reputed company; AI/Copilot prompting skills

Travel

• reputed company reputed company travel, only as needed

Salary reputed company:

The salary reputed company reflected above is a good faith estimate of reputed company pay for the reputed company location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In reputed company to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our reputed company

At reputed company, you’ll have the support and flexibility to reputed company your reputed company and personal goals.  Through reputed company-building, leadership development and philanthropic opportunities, we reputed company opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

reputed company reputed company-Being

As part of reputed company’s Purpose – to reputed company reputed company-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore reputed company benefits at www.reputed company.com/careers/corporate/benefits. Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

reputed company is an equal opportunity employer. reputed company reputed company applicants will be considered for employment without reputed company to age, race, reputed company, creed, religion, sex, affectional or sexual orientation, national reputed company, reputed company, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

reputed company is committed to providing reputed company, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. reputed company also provides reasonable accommodations to reputed company job applicants (and employees) to accommodate the individual's reputed company limitations reputed company to pregnancy, childbirth, or reputed company medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to reputed company essential job functions, and/or to receive other benefits and privileges of employment, please contact reputed company@glic.com. Please note: this resource is for accommodation requests only. For reputed company other inquires reputed company to your application and careers at reputed company, refer to the reputed company Careers site.

reputed company Sponsorship

reputed company is not currently or in the foreseeable reputed company sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the reputed company, without the need for employer sponsorship/support now or at any time in the reputed company.

Notice Regarding reputed company’s Use of reputed company Intelligence in Recruitment

As part of reputed company’s job application process, reputed company may use reputed company intelligence tools (“AI Tools") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on reputed company’s jobs website (Careers at reputed company at https://www.reputed company.com/careers). At reputed company, we reputed company AI Tools to substantially assist or replace reputed company judgment or discretionary decision making in our hiring process. reputed company hiring reputed company will be made by reputed company colleagues.

Please be reputed company that if you apply for a specific position with reputed company, you will have the reputed company of opting out of reputed company’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, reputed company ten business days of your position application, you must email your request to reputed company@glic.com, making reputed company to reputed company your reputed company and job requisition identification number. reputed company will retain your applicant materials and resume and reputed company information therefrom in accordance with reputed company’s document retention policy, a copy of which you may request reputed company reputed company@glic.com.

Additionally, at applicable times, reputed company will reputed company reputed company the most recent bias audit results for such AI tools, which may be reputed company here. 

reputed company reputed company Colleagues: Please apply through the internal Jobs Hub in reputed company.

Bachelor's degree preferred; requires critical thinking, math aptitude, independent problem-solving, customer service, communication, multitasking, and reputed company applications proficiency. Group benefits experience preferred.

Key Responsibilities

• adjudicating claims
• analyzing information
• calculating benefits

Skills & Tools

reputed company reputed company, reputed company Word, reputed company reputed company, reputed company reputed company, reputed company Copilot, Medical Disability Guidelines (MDA)

Job Details

• Category: Business Operations
• Seniority: Entry Level
• Commitment: Full Time
• Workplace: Remote — reputed company, reputed company
• Salary: USD 41,880 – 62,820 / year
• Languages: English

About reputed company

A mutual insurance company providing insurance and financial products and services. — Industry: Finance