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Job Field: Legal Jobs
Location: Glendale, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Major Duties
Manages the administrative appeal process to
ensure the resolution of grievances and appeals
consistent with organizational policies and
procedures and compliant with state and federal
guidelines.  Coordinates data collection and
review of compliance reporting and identifies
opportunities for service improvements.  Oversees
daily operations and case load
assignments/priorities.  Requires college degree
and 3-5 years experience in Disability Insurance
Claims environment.
Most senior non-management claims examiner
position, responsible for rendering a final claim
determination on the complex appealed cases.
Determines required expert resources at each
juncture and solicits input. Based on appeal
investigation, determines whether claim is
reopened or original denial was appropriate.
Proactively communicates with claimants, their
representatives, employers, providers, account
management and the core team case management to
resolve investigation issues and communicate
decisions/rationale for denial/approval. May
provide direction to more junior claims examiner
positions.
Example of specific role functions
-Review fundamental factors, like policy usage and
apply your expertise to make sure contract is
applied appropriately such as the correct policy
provisions, eligibility, benefits, exclusions and
employee class.
-Determine the appropriate resources to utilize in
appeal resolution,  whether or not to use an
external medical evaluation or medical records
reviews,  what type of vocational resources to
utilize, whether or not to involve a CPA to help
interpret the policy in order to resolve these
claim disputes accurately, objectively and fairly.
-More generally, the key exercise of discretion is
the ability to consider the totality of the claim
and determine appropriate resolution based on the
interpretation of the claim file documentation.
Qualifications
-Typically requires a BA/BS degree or equivalent
work experience
-Minimum of 3 years in an LTD claim environment
-Manages all appeals according to our CIGNA
Pledge, Claims Philosophy and Superior Care
Management metrics.
For More Details Please See the Below URL.

KEY REQUIREMENTS:

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None Bachelors degree