HR Short Term Disability Claims Coordinator

This individual will be responsible for the medical case management process of STD claims, which includes assessment, planning, coordination, implementation, and evaluation of the disabled individuals. The Nurse Case Manager will be expected to work as an intermediary between medical care providers, attorneys, the employer, and employees to closely monitor the progress of the disabled and report back results to the employer. This will ensure appropriate and cost-effective healthcare services leading to a medically rehabilitated individual who is ready to return to an optimal level of work and functioning.

*This is a remote opportunity

The primary responsibility of this role is to manage and monitor the Short Term Disability and/or Statutory Disability claims processes to ensure timely and accurate claim decisions are made and administered on behalf of the organization.

• Manage the overall caseload of STD, Statutory Disability and/or Family & Medical Leave Act (FMLA) claims while remaining in full compliance with regulatory requirements. 
• Evaluate claimant eligibility (via information received from claimant and attending physician) to determine the validity and expected length of a claim (whether to return, pend, deny or pay claims). 
• Follows and ensures claims processing is consistent with applicable policies, regulations, procedures and department guidelines for disability claims.
• Documents the claims system in an accurate and comprehensive manner while maintaining maximum levels of efficiency and confidentiality.
• Prepare and articulate written and verbal communication to assorted internal and external sources. 
• Able to recognize overall process insufficiencies, cost reductions, and opportunity for processing enhancements. 
• Responsible for managing the STD claims team but is not limited to the following:
• Support overall claims team by creating a positive work environment, consistently maintain professionalism and integrity, demonstrate a dedication to excellence, and actively take steps to foster high morale.
• Ensure case workloads are appropriately balanced among team members along with providing team members with the resources needed to succeed.
• Provide technical expertise and direction to team members on claims adjudication for STD.
• Facilitate the transition from STD to Long Term Disability (LTD), in accordance with the timeline, process, and data requirements as set for between CommonSpirit Health and the LTD insurance company.
• Process increasingly complex assigned claims for payment or denial in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality and production standards. 
• Obtain needed claim information by communicating effectively with internal and external stakeholders verbally and in written form while maintaining a professional demeanor in all interactions. 
• Provide customer service to internal and external stakeholders and recognize what needs to be completed to meet customer needs. Demonstrate flexibility and responsiveness to customers. 
• Perform other related duties and activities as required.
• Medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment along with medical reviews as applicable to claim handling laws and regulations.
• Responsible for helping ensure disabled parties receive appropriate treatment directly related to the disability in question and assist claim handlers in managing medical treatment to an appropriate resolution.
• Maintain all case documents in files ensuring a comprehensive and detailed source of information for all parties involved in the case. As well as, document and report case activity for accurate case management and billing.
• Prepare detailed evaluation reports and maintain contact with all parties involved to monitor, update, and advance case activity to ensure the progress of the case.

The job summary and responsibilities listed above are designed to indicate the general nature of the work performed within this job. They are not designed to contain or be interpreted as a comprehensive inventory of all job responsibilities required of employees assigned to this job. Employees may be required to perform other duties as assigned.

• Bachelor's Degree or equivalent work experience (4 years of experience in lieu of Bachelors)
• Extensive knowledge of the leave requirements and other legal protections afforded by the FMLA, ADA, and other applicable laws.
• Experience in Short-Term Disability claims that directly align with the specific responsibilities for this position
• Excellent organizational skills and attention to detail.
• One year experience with disability/leave of absence claims preferred.
• Ability to manage confidential and sensitive employee information and adhere to strict data privacy standards.
• Comfortable working in a high-energy, quickly changing and demanding environment
• Excellent verbal and written communication skills.
• Strong attention to detail and organizational skills.

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.