Location: Cincinnati, OH / Hybrid / Remote
Duration: 6 months
Act as a subject matter expert for short term disability claims
Interpret disability plans and insurance policies for claim decisions
Serve as a liaison between claimants, employers, and clinical teams
Ensure compliance with disability regulations and company guidelines
Support return-to-work and vocational rehabilitation initiatives
Provide guidance on eligibility and benefits structure
Handle escalations and complex case scenarios
Collaborate with clinical and vocational resources for case evaluation
Drive process improvements in claims operations
Maintain high standards of customer service and communication
Manage disability case management and claim adjudication based on medical documentation
Review and analyze medical records including diagnostic tests, office notes, and operative reports
Determine claimant eligibility as per disability plan definitions
Conduct outreach to employees, physicians, and employers for missing documentation
Utilize clinical guidelines and in-house clinicians for case assessments
Partner with clinical and vocational teams to evaluate disability and return-to-work plans
Approve, deny, and authorize claims under short term disability policies
Determine benefits due and process timely payments and adjustments
Communicate claim status and expectations via phone and written correspondence
Manage workload, client deliverables, and second-level escalations
Process claims involving Workers Compensation and disability offsets
Refer complex cases to team leads or clinical case management
Perform peer reviews to ensure accuracy and timeliness
Experience in short term disability or disability claims management
Strong knowledge of disability plans and insurance processes
Ability to interpret and review medical documentation
Knowledge of Workers Compensation and disability offsets
Strong analytical and decision-making skills
Experience in claims adjudication and benefit determination
Excellent verbal and written communication skills
Ability to manage high-volume workloads
Attention to detail and accuracy
Familiarity with clinical guidelines and case evaluation
Disability Claims Management
Case Adjudication
Medical Records Review
Benefits Determination
Regulatory Compliance
Customer Communication
Case Management
Process Improvement
Workload Management
Quality Assurance
4-6 years or above