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LTD Claims Adjuster

Company: AppleOne
Location: Simi Valley
Posted on: June 24, 2019

Job Description:

Long Term Disability Claims Adjusters Needed! Position Summary: Under general supervision, this position adjudicates Long Term Care Insurance claims. Work involves the interpretation of insurance contracts and benefits schedules, and requires excellent judgment and accurate computation ability. Work also involves extensive personal contact with others and/or can be of personal or sensitive nature. Work may involve motivating or influencing others. Recognizes the special needs of elderly claimants and their families, and acts to fulfill those needs in prompt and courteous manner. Fostering sound, amicable relationships with individuals or entities inside and outside the Company is necessary.Primary Responsibilities:Accurately interprets Long Term Nursing Care policy language and executes accordingly.Makes eligibility recommendations for Supervisor consideration.Accurately documents rational for claim direction and updates as needed.Assesses various types of new information to support claim direction.Recommends Nurse Care Manager Visits, Medical Consultant Reviews, Surveillance, Independent Medical Evaluations when required.Timely handling of mail and correspondence to meet/exceed company standards.Communicates with claimants/representatives via phone, e-mail, letter or fax.Handles incoming calls and returns voice mail messages timely.Manages daily reports to assure productive claim handling.Ability to work in an environment that embraces Best Practices.We are an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, sex, sexual orientation, age (40 and over), gender identity, national origin, protected veteran status, disability or any other protected classification under federal and state law.

Keywords: AppleOne, Simi Valley , LTD Claims Adjuster, Other , Simi Valley, California

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