Claims Examiner (LTD)
Job ID #: FO-CT-Claims Examiner (LTD)
Location: CT-Farmington
Functional Area: Claims
Company Name: American General Life Companies
Employment Type: Full Time - Regular
Education Preferred: Bachelors
Experience Required: 3-5 years
Relocation Provided:


Position Description
To provide claim adjudication on LTD claims by reviewing all clinical and non-clinical information pertinent to the file and make claims decisions within a timely manner.
Responsibilities:
1.Ability to determine claimant eligibility through review of the established policy and contact with the ER to obtain the necessary information.
2.Determines severity of illness based on disabling diagnosis, to include assessment of functional capacity compared to the disabled individual’s job requirements.
3.Contacts employers and employees as necessary to determine functional requirements of work duties. Contacts physicians as necessary to determine severity of illness based on disabling work duties.
4.Maintains accurate file documentation utilizing TAM system.
5.Assesses health records and medical reports.
6.Determines length of disability and the rationale utilized to calculate length of disability. Communicates this information as defined in customer agreements.
7.Determines timely and appropriate follow-up with disabled employees, physicians and employers in order to pro-actively manage cases. Establishes diaries as necessary to effectively manage individual caseload.
8.Optimizes the use of vendor service resources in order to maximize the disabled employee’s potential for safe return to work.
9.Acts as a technical resource to customers, clients and other team members as needed.
10.Works with the case manager to coordinate MD referral, Independent Medical Exam, Functional Capacity Evaluation and Surveillance as necessary.
11.Educates employees, customers and physicians on the managed disability claim process to expedite and facilitate appropriate claim outcomes.
12.Provide prompt and accurate payment and/or adjustment of claims, and communicates decisions to claimant and customer in a timely manner.
13.Seeks guidance from LTD Case Managers as needed.
14.Provides open communication to the employee regarding their claims status.
15.Performs other related projects and duties as assigned.

Position Requirements
At least 3 years of previous experience in a managed care, health care or general business setting with at least 1 year of disability management experience required. Valid RN license required, BSN or OT preferred. Bachelors Degree preferred. Previous experience in determining benefit calculations. Excellent math and analytical skills. Solid computer skills using Microsoft Windows products and the Internet required.

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About Us
Service. Commitment. People. Products. These are the reasons people choose to do business with American General Life Companies. And the reasons why we are the right choice for your career. At American General Life Companies, we have been keeping promises to American families and businesses for more than 150 years. Our insurers offer a broad spectrum of fixed and variable life insurance, annuities and accident and health products to serve the financial and estate planning needs of customers throughout the United States.