Director, Disability Claims, Job # 9683

Leadership /Technical Disability Claims Knowledge/Presentation Skills

Your role as Director, Disability Claims is of key importance in delivering on our stewardship of superior disability case management while ensuring that claims are proactively managed and closed in a timely manner.

When our client sells an employee group disability insurance policy, they are selling their expertise in claims adjudication and management. The client's claims management is balanced, demonstrating an empathetic understanding and approach to our claimants while at the same time following an evidence-based objective medical model.

You will be the final decision-maker on claims adjudication recommendations from the outsourced claims team. Your decisions may include providing further guidance for the review of the claim based on your deep disability claims management expertise. You will share that expertise through maintenance of the Claims Manual, collaborating with Human Resource teams at key clients, and reviewing the capabilities of claims team members.

Major Responsibilities

1. Reviewing and authorizing claims recommendations
2. Acting as an expert on disability claims, disability treatments, investigations, and related claims activities
3. Working closely with the claims team and legal counsel to effectively manage litigated cases
4. Ensuring accountability through the claims service chain
5. Reviewing and authorizing appropriate treatment and measuring efficacy
6. Deploying the appropriate medical and vocational specialists to work with employers and employees with the common goal of return to work
7. Collaborating with team members and colleagues to identify opportunities and solutions for process improvement and automation
8. Ensuring adherence to the company's claims adjudication methodology and service standards

1. You are an expert in disability claims management
2. You enjoy sharing your knowledge and experience with colleagues and customers
3. You are comfortable making evidence-based decisions that can be supported if contested by claimants, clients, or legal counsel
4. You believe in the importance of early intervention and active case management
5. You understand the importance of data and reporting in the management of claims, the team, and the sharing of outcomes with the senior leadership team
6. You enjoy knowing that everything you do has a direct and measurable impact on the organization

1. Expert knowledge of disability claims acquired through a minimum of 8-10 years of group benefits experience, must be in a claims leadership role
2. Strong written, presentation, and verbal communication skills and comfortable in a client-facing role
3. A decision maker
4. Comfortable representing the company in mediations and lawsuits