Senior Disability Claims Examiner (LTD) (Virtual)

Job Classification:

Operations - Insurance Operations

Senior Disability Claims Examiner:

Prudential is a company of smart, ambitious professionals working together across a multitude of disciplines. Together, we are building a better financial future for our customers and our communities around the globe. At Prudential, we understand that a company is only as good as its people. This simple fact is central to all that we do.

The Team

You will be part of the Long-Term Disability (LTD) Claims team which is part of our Group Insurance Business.  We have Long-Term Disability teams based out of New Jersey, Maine, and Arizona as well as fully remote teams.

The Role

The Long-Term Disability (LTD) Senior Disability Claims Examiner is responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. As a claim manager you will partner with medical and vocational resources to evaluate disability and support return to work goals. Additional responsibilities include:

• Deliver an exceptional customer experience that serves to differentiate Prudential from our competitors and ensures that customer commitments and deliverables are achieved.                                                                

• Communication via telephone, email, and text with employees, employers, attorneys, and others.

• Review and interpret medical records, utilizing resources as appropriate. 

• Complete financial calculations

• Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered.

• Apply contract/policy provisions to ensure accurate eligibility and liability decisions.

• Demonstrate and apply analytical and critical thinking skills.

• Verify on-going liability and develop strategies for return-to-work opportunities as appropriate.

• Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication.

• Leverage a broad spectrum of resources, materials, and tools to render claims decisions.

• Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards.

• Work within a fast-paced environment, with tight deadlines and the ability to balance multiple priorities.

• Provide technical direction and/or mentorship to other claims personnel as needed.

• Work independently as well as within a team structure.

What you’ll need to succeed:

• 4+ years of experience in Long Term Disability Claim Management required

• Exceptional customer service skills

• Ability to solve complex claim scenarios with minimal mentorship

• Excellent claim/risk management skills and technical knowledge in contract interpretation and administration

• Proven skills in positive and effective interaction with challenging customers  

• Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English)

• Excellent organizational and time management skills with ability to multitask and prioritize deadlines.            

• Ability to manage multiple and changing priorities.

• Detail oriented; able to analyze and research contract information.

• Demonstrated ability to operate with a sense of urgency. 

• Experience in effectively meeting/exceeding individual professional expectations and team goals.                                

• Demonstrated analytical and math skills.                                        

• Ability to exercise critical thinking skills, risk management skills and sound judgment.        

• Ability to adapt, problem solve quickly and communicate effective solutions.                                   

• High level of flexibility to adapt to the changing needs of the organization. 

• Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.

• Continuous improvement mindset

• A commitment to suppor