Lead Disability Case Manager - Operations

T4 - Lead Operations (Disability Case Manager)

Our story

At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.”

Our Values:

Champion People – be empathetic and help create a place where everyone belongs.

Grow with purpose – Be inspired by our higher calling of improving lives.

Be Alight – act with integrity, be real and empower others.

It’s why we’re so driven to connect passion with purpose. Our team’s expertise in human insights and cloud technology gives companies and employees around the world the ability to power confident decisions, for life.

With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.

Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.

Learn more at careers.alight.com. 

Position Objective: The STD Claims Case Manager (CCM) is responsible for administering and case managing assigned Group Short Term Disability claims according to the plan provisions, state and federal guidelines, and established protocols.   The CCM works jointly with other team members within STD, and LTD and Risk Management resources. The CCM must demonstrate the knowledge to work independently, make timely claim decisions, and must possess the knowledge and experience which allows performance of the daily activities of the job with minimal supervision.

The CCM is responsible for meeting key service deliverables for turnaround times, quality assurance, and overall customer experience.

Major Opportunities and Decisions:

This position utilizes problem solving, analytical, written and verbal communication skills to ensure timely and appropriate disability claim decisions while providing superior customer service to all internal and external customers.  This position will review claims for Short Term Disability and requires consistent and effective claim management skills to succeed in a collaborative, team-oriented culture with a goal to drive positive claim outcomes. 

Principal Accountabilities:

Communication (Verbal and Written)                                                                                                                                    

• Use most efficient and effective means of proactive outreach to obtain and/or dispense information to and from claimants, departmental managers, physicians, HR, Payroll, or any other sources.   
• Communicate claim status and decisions via telephone and in writing 
• Initiate communications to claimant, physician, and /or Plan holder to obtain information,

make assessment and initial claim decision

• Proactive outreach to claimants, plan holders, and physicians via telephone for information needed for initial and ongoing claim management (e.g. tax returns, partnership records, current earnings other income benefits and medical information etc.,); notifies claimant when claim pended for missing information

                        

  Investigate/Analyse                                                                                                                                                      

• Investigate and analyse claim information to determine coverage and benefit eligibility, perform pre-existing condition investigation and draft adverse determination letter, if applicable.  Perform contestability investigation, evaluate for possible rescission and make rescission determination and draft letter if applicable
• Determine disability by comparing functionality with job description by reviewing medical information including physician statement(s) and medical records to set up claim for initial benefit approval
• Determine Insured Earnings by reviewing payroll records, tax returns (including W2s), partnership records and buy sell agreements and calculate payable benefits according to plan provisions
• Follows claim management procedures and identifies potential return to work, job accommodation opportunities when applicable.
• Utilizes claim management resources, i.e. MDA (Medical Disability Advisor), and other disability guidelines, with a goal of returning claimant to active work status

• Assess claim when other sources of income are received (e.g., social security, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits as needed determining under/overpayments.   Proactively work with claimants to recover overpayments in full or negotiate monthly instalments according to established protocol

    Skills and Knowledge:

• Excellent analytical, problem solving, and communication skills (verbal & written) essential
• Minimum 2 years of disability claim management experience (STD preferred), or other previous Group insurance experience
• Regulatory and Compliance experience a plus
• Ability to multi-task and meet turnaround times

• Ability to clearly communicate claim decisions and contract language verbally and in written correspondence
• Understanding of medical terminology and medical conditions helpful

Education and Experience:

• Graduate in listed discipline (BA, B.Com, BCA aggregate marks of >=55% ( No Gaps / Failure throughout Graduation)
• Work Experience of 6 years +
• Ability to work evening/night shifts
• Minimum 2 years of disability claim management experience (STD preferred), or other previous Group insurance experience
• Regulatory and Compliance experience a plus

Benefits

We offer programs and plans for a healthy mind, body, wallet and life because it’s important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as a number of voluntary benefit options. 

By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight’s employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test.  You will be notified during the hiring process which checks are required by the position.

Our commitment to Diversity and Inclusion

Alight is committed to diversity, equity, and inclusion. We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.

At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

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Experience Level

Senior Level