PHRN | Claims Analyst - Short Term Disability | Taguig/Davao/Clark

A Claims Analyst-Short-Term Disability is responsible for reviewing and evaluating incoming Short Term Disability claims, determining eligibility based on medical documentation and policy guidelines, communicating with claimants and employers, and making decisions regarding claim approval, denial, or continuation, all while adhering to legal and company standards; essentially managing the entire lifecycle of a short-term disability claim from initial submission to closure.

• Claim intake and review: Receiving and reviewing initial STD claim applications, including medical documentation, employment information, and policy details.
• Medical evaluation: Assessing the severity of the claimant's medical condition by reviewing medical records, consulting with medical professionals when needed, and determining functional limitations.
• Eligibility determination: Analyzing the claim against the company's STD policy guidelines to determine if the claimant is eligible for benefits.
• Claim adjudication: Making informed decisions to approve, deny, or partially approve a claim based on the evaluation of medical information and policy terms.
• Claim communication: Maintaining regular contact with claimants, employers, and healthcare providers to gather necessary information, provide updates on claim status, and address any concerns.
• Return-to-work coordination (Philippines): Working with claimants and employers to facilitate a smooth return to work process, including exploring potential accommodations.
• Claim monitoring: Regularly reviewing open claims to ensure timely processing, identify potential issues, and manage claim duration.
• Compliance management: Adhering to all applicable state and federal laws regarding disability benefits, including reporting requirements.
• Documentation and reporting: Maintaining detailed case files, documenting all claim actions, and generating necessary reports for internal and external stakeholders.

Qualifications:

• Strong analytical skills to interpret medical documentation and policy guidelines
• Excellent communication skills to interact effectively with claimants, employers, and healthcare providers
• Detail-oriented approach to ensure accuracy in claim processing
• Knowledge of disability laws and regulations
• Ability to make sound decisions based on complex medical information
• Experience with claims management systems
• Philippine Registered Nurse