Senior Consultant , LTD Claims Investigation Services

• Audit files to prevent, detect, and mitigate suspicious activity
• Triage files with case managers and clinical and vocational staff
• Coordinate background checks and surveillance with vendors
• Manage and prioritize groups of claims while maintaining appropriate documentation
• Obtain pertinent information to evaluate claim credibility
• Use investigative tools
• Testify in court cases and provide depositions related to claim disputes
• Assist Case Managers with claims investigations and adjudication
• Collaborate with claims colleagues on case management strategies
• Liaise with Compliance when misrepresentation is suspected

• 3+ years’ experience managing Group Disability Claims, strongly preferred
• Demonstrated expert analytical skills
• Ability to think creatively and assess claim strengths, weaknesses, and contract-language distinctions
• Excellent written and verbal communication skills with client service orientation
• Ability to work independently and in a team environment
• Ability to conduct detailed claimant interviews
• Solid critical thinking and negotiation skills
• Ability to work with a diverse range of people

Demonstrates expertise in managing Group Disability Claims, utilizing strong analytical and critical thinking skills to assess claim credibility and negotiate effectively. Proficient in collaborating with diverse teams and communicating clearly with clients and stakeholders.

• Group Disability Claims Management
• Expert Analytical Skills
• Claim Investigation and Adjudication
• Excellent Written and Verbal Communication
• Critical Thinking and Negotiation Skills

• Claims Evaluation
• Investigative Tools
• Claimant Interviews
• Documentation Management
• Case Management Strategies

• Creative Thinking
• Client Service Orientation
• Team Collaboration
• Independence
• Diversity Awareness

• Claims Disputes
• Background Checks
• Surveillance Coordination
• Compliance Liaison
• Misrepresentation Detection