Bi-Lingual Spanish Short Term Disability Claims Examiner

Custom Disability Solutions - Group Reinsurance Division of Reliance Standard Life Insurance Company (www.rsli.com).  CDS has an excellent opportunity for a claims professional that would like to contribute and thrive in an environment that has a commitment to our employee's professional growth in a collaborative and fun team atmosphere.Enjoy your career with some of the most experienced people in the industry. Fluency in Spanish with the ability to provide good verbal and written communication skills are required. Principal Objective: Contribute to and support Custom Disability Solutions' approach to disability management by making fair, accurate claim decisions ensuring proper adjudication of claims according to policy/plan provisions. Initiate and facilitate case management and other ancillary services to assure optimum outcomes. Dimensions/Scope of Position: Accounts and authority levels are defined by Claims Leader and are directly related to training and experience. Duties include initial and ongoing assessment and management of all claims to determine eligibility based on specific policy information. STD Benefit Consultant I: Under general supervision and within authority limits, investigate and manage disability claims, facilitating optimal resolutions. STD Benefit Consultant II: Under general supervision and within authority limits, investigate and manage disability claims, facilitating optimal resolutions. Assist with management of complex claims.Senior STD Benefit Consultant: Under limited supervision and within authority limits, investigate and manage disability claims, facilitating optimal resolutions. Assist with management of complex claims. Provide support with training and mentoring other Benefit Consultants.

Essential Duties/Responsibilities:1. Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs.2. Consistently adhere to the documented workflow guidelines and established procedures.3. Maintain required levels of confidentiality.4. Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education.5. Maintain working knowledge of assigned policies and accounts.6. Verify eligibility, apply correct circumstance of disability in accordance with contract language to develop investigative procedures and ensure proper adjudication of claims.7. Timely coordination with appropriate parties to assure seamless claim integration.8. Maintain written and verbal communications with claimant, providers, employers, and clients to collect data and provide relevant information.9. Obtain and analyze relevant information, including and not limited to medical records and financial data, and apply circumstances of disability in accordance with contract language and established procedures. 10. Evaluate and assess the functional capability and duration of disability.11. Maintain telephonic and written communication regarding claim determination and explanation of supporting documentation.12. Evaluate the need for and coordinate clinical and/or vocational intervention.13. Using resources, direct vendor services and activities on referrals by outlining and communicating specific service requests and ensuring service quality and related expense.14. Maintain accurate documentation of all information in paper form/on claim administration system to ensure claim payments and reports are processed correctly and timely. 15. Calculate benefit and identify other income replacement benefits. Process financial activities, including but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Process overpayments in accordance with established procedures. 16. Handle claims, mail and diaries in accordance with defined claim procedures, ERISA, Fair Claim Settlement Practices Acts, and other statutory regulations.17. Assist in the subrogation process to recover money from third parties.19. Maintain a level of participation and commitment to individual, team, and CDS results by retaining responsibility for the optimal outcome of individual files. Assist management in unit activities/projects that support unit objectives. Inform Claims Manager of any trends noted within specific client companies.

Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Physical requirements are that of sedentary work level, exerting a negligible amount of force occasionally to push, pull, lift or otherwise move claim files. This position involves sitting most of the time. Visual acuity requirements are similar to a clerical administrator whose work primarily deals with working on a computer terminal and reading written materials. Repetitive motion or keyboard usage is a requirement of the job. Hearing requirements are also frequently used to perform services. Incumbent must be able to adequately use a calculator, printer, telephone, computer terminal/relevant programs. We are looking for individuals who have: Excellent work ethic Focus on Outcome Negotiation skills Intuitive/Sleuthing abilities Analytical Thinking Strong Written/Communication Skills Excellent Customer Service  Education Requirements And Other Requirements: Ability to read and interpret medical data and other documentation. Good working knowledge of policy/plan provisions and state regulations with capability to amalgamate this information and apply the results to disability claims. Exceptional interpersonal and communication skills, both written and verbal. Aptitude to work effectively both independently and as part of a team. Ability to make sound decisions. Maintain good internal/external working relationships. Multi-tasking and conflict management essential Spanish Bi-Lingual candidates Successful candidate would be able to write, read and speak fluent Spanish. Benefits We have a very competitive benefits and compensation program. See our company profile for more information on benefits and other employee special programs. www.customdisability.com Custom Disability Solutions is an equal opportunity employer