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Senior Disability Claims Examiner – LTD

Remote · Sri Lanka Full-time

Job Description:

  • Responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims.
  • Expected to utilize judgment and assess risk as you work with various business partners to render claim decisions.
  • Partner with medical and vocational resources to evaluate disability and support return to work goals.
  • Deliver an exceptional customer experience that serves to differentiate Prudential from our competitors and ensures that customer commitments and deliverables are achieved.
  • Communication via telephone, email, and text with employees, employers, attorneys, and others.
  • Review and interpret medical records, utilizing resources as appropriate.
  • Complete financial calculations.
  • Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered.
  • Apply contract/policy provisions to ensure accurate eligibility and liability decisions.
  • Demonstrate and apply analytical and critical thinking skills.
  • Verify on-going liability and develop strategies for return-to-work opportunities as appropriate.
  • Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication.
  • Leverage a broad spectrum of resources, materials, and tools to render claims decisions.
  • Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards.
  • Work within a fast-paced environment, with tight deadlines and the ability to balance multiple priorities.
  • Provide technical direction and/or mentorship to other claims personnel as needed.
  • Work independently as well as within a team structure.

Requirements:

  • 4+ years of experience in Long Term Disability Claim Management required.
  • Exceptional customer service skills.
  • Ability to solve complex claim scenarios with minimal mentorship.
  • Excellent claim/risk management skills and technical knowledge in contract interpretation and administration.
  • Proven skills in positive and effective interaction with challenging customers.
  • Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English).
  • Excellent organizational and time management skills with ability to multitask and prioritize deadlines.
  • Ability to manage multiple and changing priorities.
  • Detail oriented; able to analyze and research contract information.
  • Demonstrated ability to operate with a sense of urgency.
  • Experience in effectively meeting/exceeding individual professional expectations and team goals.
  • Demonstrated analytical and math skills.
  • Ability to exercise critical thinking skills, risk management skills and sound judgment.
  • Ability to adapt, problem solve quickly and communicate effective solutions.
  • High level of flexibility to adapt to the changing needs of the organization.
  • Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
  • Continuous improvement mindset.
  • A commitment to support a work environment that fosters Diversity and Inclusion.
  • Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.

Benefits:

  • Market competitive base salaries, with a yearly bonus potential at every level.
  • Medical, dental, vision, life insurance, disability insurance.
  • Paid Time Off (PTO), and leave of absences, such as parental and military leave.
  • 401(k) plan with company match (up to 4%).
  • Company-funded pension plan.
  • Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.
  • Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.
  • Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.
  • Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.
  • Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance.

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