LTD Claims Team Lead

The Role at a Glance

We are excited to bring on a LTD Claims Team Lead to support the Workplace Solutions Claims organization in a work from home environment.

Background Details

The LTD Claims Team Lead will play a critical part in helping individuals navigate challenging life events by managing complex long-term disability (LTD) claims with care, empathy, and expertise. You'll leverage strong analytical and problem-solving skills to investigate claims, evaluate information, and make thoughtful coverage and claim determinations while ensuring compliance with policy provisions and regulatory requirements. You'll work with highly confidential and sensitive information, requiring strong judgment, professionalism, and a commitment to protecting privacy.

As a trusted resource within the organization, you'll provide technical guidance and support to colleagues while helping ensure claims are managed fairly, ethically, and efficiently. This role offers the opportunity to make meaningful decisions, collaborate with a variety of stakeholders, and positively impact the experience of those relying on disability benefits during important moments in their lives. If you enjoy evaluating complex situations, making informed decisions, and balancing compassion with accountability, please read on!

What you'll be doing

• You will manage a partial caseload of complex LTD claims that cover a variety of eligibility types, policy provisions, and/or multiple diagnoses and claim factors. You will apply claims policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
• You will monitor and evaluate individual/team performance and takes appropriate action to meet or exceed standards. You will serve as a role model, mentoring others to build & leverage claims knowledge & relationships to enhance claims management and internal/external customer experience.
• You will approve and make claim management related financial decisions consistent with company guidelines for assigned area(s).
• You will provide technical guidance to claim team members on claims adjudication for assigned area(s).
• You will review and resolve escalated issues and concerns for assigned area(s) of responsibilities. You will escalate issues as needed to management.
• You will maintain stable inventory through timely and appropriate risk management and efficient processing of work.
• You will utilize strong judgment and knowledge of claims management to make decisions based on information available at the time of decision.
• You will research questions and escalations from Claims team, liaising with various stakeholders from across the business (Underwriting, Actuarial, Compliance, Account Management, etc.) to obtain needed information to clarify and address issues. You will provide customers with in-depth explanations of policy details, claim process, and claim determination, ensuring parties understand the information and outcome.
• You will utilize internal reporting to identify trends and review/audit performance against team metrics; you will propose and develop practices & processes to improve performance and the customer experience.
• You will effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims workflow. You will provide detailed guidance & coaching to junior team members.
• You will provide input on potential impact of proposed processes on current operational approach as well as compatibility with applicable system(s).
• You will identify and resolve gaps in financial calculations and offsets when applicable, sharing technical knowledge and approach on financial calculations with team members. You will interpret calculations correctly involving complex contract provisions and work with applicable resources as needed to resolve issues.
• You will participate in departmental projects and/or leads project workstreams as needed.
• You will identify and communicate to management process improvements that reduce workloads or improve quality for their assigned area(s) of responsibility.

What we’re looking for

• 4 Year/Bachelor's degree or equivale