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Lead Benefit Claim Specialist (Workplace Solutions)-Remote

Company: Mutual of Omaha
Location: Omaha
Posted on: August 8, 2022

Job Description:

Ensures the accurate, prompt and thorough evaluation and management of Disability claims by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry leading customer experience. This role has a direct impact on the success of BSD from both a financial and persistency (customer retention) perspective.

Independently performs end to end claims evaluation, management and adjudication for Disability claims beginning at the point of notification through the maximum benefit/duration of the claim, with the primary accountability being accurate and timely decision making of approved or denied liability benefits for the duration of the claim by managing the claim to the appropriate duration based upon claim facts, effective and efficient case management, as well as communicating decisions both verbally and in writing to the claimant and employers

Requires a high level of independent decision making and critical thinking. Claims analysis includes but is not limited to: eligibility determination for both initial and ongoing benefits is based on the medical information received, contract analysis, customer service, fraud detection and awareness, financial calculations, interpreting and analyzing medical and vocational information and adhering to all statutory/governmental regulations. This includes analyzing the information received, determining if additional information is required in order to make a benefit decision. This position regularly communicates with employers, medical professionals (including physicians) and claimants.


  • Makes sound / autonomous decisions throughout the life of the claim (initial adjudication and ongoing claims management) based upon claim facts, thorough evaluation, and gathering pertinent information, to formulate appropriate action plans.
  • Develops file that demonstrates appropriate decision making based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
  • Develops appropriate business relationships and communications with claimant, broker, sales organization, vendor partners, employer and internal partners (e.g. underwriting, legal, etc.). Communications demonstrate a high level of customer service and professionalism that support the values of Mutual of Omaha.
  • Initiates regular and appropriate communication with claimants, employers and medical professional(s) throughout the life-cycle of the claim. This includes initial and ongoing claim decisions.
  • Reviews and determines continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions, and determining any change in status or benefits. Requires interaction and coordination with internal and external partners including but not limited to brokers, sales organization, clinical and physician resources, vocational experts, vendor partners and financial resources.
  • Accurately determines financial liability based on salary, other income sources, medical / vocational information and contract language. Has autonomy to approve initial and ongoing payments based upon holistic file evaluation. Role is responsible for accurate and timely transition of claims to the LTD organization.
  • Communicates any changes in liability or claim status to claimants, policyholders, and appropriate home office departments.
  • Provides various reports to policyholders per contract requirements with a high level of customer service.
  • Determines eligibility based on contract language, payroll records, and other supporting documentation.
  • Adheres to ERISA and other federal/state laws concerning group disability insurance.
  • Demonstrates flexibility and ability to execute unique customer requirements.
  • Creates written letters for the purpose of providing concise explanations to claimants regarding claims determinations.
  • Remains abreast to industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.
  • Demonstrates independent decision-making skills.
  • Formulates and interprets diverse concepts within product variables.
  • Discretionary authority to commit to decisions that have financial impacts within established parameters.
  • Responsibility to troubleshoot, problem solve and make recommendations concerning policies and procedures.
  • In addition to the above, the Lead Benefit Claim Specialist position is expected to be an expert in the claims process and has accountability for the development of team members. This role is proactive in issue identification, mentoring and development plans for all Benefit Claim Specialists and Sr Benefit Claim Specialists regardless of experience level. Assists with customer implementations and large case customer relationships. Is a leaders and initiator of departmental projects, assists with the management of a team and is a back up to the Team Manager. The ideal candidate of the Lead Benefit Claim Specialist will aspire for leadership roles. Additionally, a Lead Benefit Claim Specialist is expected to manage a more complex and diverse caseload (i.e. concurrent LWOP, Leave). ABOUT YOU:

    This position is multifaceted and diverse, requiring many different skill-sets in order to be effective including:
    • You help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
    • You are able to work remotely and have access to high-speed internet.
    • Must be located in United States or Puerto Rico
    • Understanding of complex insurance provisions and contracts.
    • Ability to comprehend and apply insurance regulations to claim situations.
    • Ability to interpret vocational and medical information to formulate claim decisions.
    • Ability to communicate professionally with a high level of customer service (written and verbal).
    • Ability to accurately calculate complex disability benefits (i.e. residual, partial, etc.).
    • College degree or equivalent industry experience.
    • Seasoned knowledge of disability claims procedures.
    • Knowledge of disability and group insurance.
    • Strong knowledge of medical terminology.
    • Excellent analytical and decision-making skills.
    • High Level of independent decision making and critical thinking capabilities.
    • Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.
    • Knowledge/skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel, and Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
    • Strong organizational skills, attention to detail with a high degree of accuracy, and the ability to work independently and apply a sense of urgency.
    • Ability to meet deadlines.
    • Ability to diffuse situations and escalate involve management when necessary.
    • Ability to adapt to a changing environment.
    • Fair, equitable, and consistent treatment of claims is necessary for accurate financial payments and policyholder retention and satisfaction. VALUABLE EXPERIENCE:
      • 1-3 years of experience in the recertification of permanent and total disability claim block WHAT WE CAN OFFER YOU:
        • A diverse workplace where associates feel a sense of belonging. To learn more about our commitment of Diversity, Equity and Inclusion, please visit our website
        • An organization that feels like a small, close-knit community and has the strength of a Fortune 500 company.
        • Tuition reimbursement, training and career development.
        • Comprehensive benefits plan that includes medical, dental, vision, disability and life insurance.
        • Flexible spending accounts for healthcare and childcare needs.
        • 401(k) plan with a 2% company contribution and 6% company match.
        • Competitive pay with an opportunity for incentives for all associates.
        • Flexible work schedules with a healthy amount of paid time off.
        • For more information regarding available benefits, please visit our Career Site.
        • Salary Range: Minimum: $55,920 MidPoint: $72,695 Maximum: $89,470
        • Pay commensurate with experience.
        • Recognized as a certified Great Place to Work . MUTUAL OF OMAHA:

          Mutual of Omaha serves more than 4.8 million individual product customers and 39,000 employer groups. Our legacy of stability creates an environment where every associate is encouraged to experiment, innovate and grow in their own unique career path.

          From day one, youll have the tools to be your best self at work. Here youll do meaningful work and your talents will have a positive impact on peoples lives as we help our customers protect what they care about and achieve their financial goals.

          Each associate is a unique contributor to creating a diverse, dynamic, thriving and inclusive workplace. We want you to become engaged feel a sense of belonging and contribute to the companys exceptional future.

          We are committed to optimizing flexible work. We support a full range of work approaches: fully remote, hybrid and in-person. Many of our roles are remote. Employees in remote roles may occasionally travel to a Mutual of Omaha office or elsewhere for required meetings or team-building events. Remote employees who are assigned a Mutual of Omaha office location can work on-site on a voluntary basis..... click apply for full job details

Keywords: Mutual of Omaha, Omaha , Lead Benefit Claim Specialist (Workplace Solutions)-Remote, Other , Omaha, Nebraska

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