Disability Case Manager

Disability Case Manager

The Disability Case Manager is responsible for administering and case managing assigned Group Short Term Disability claims, following plan provisions, state and federal guidelines, and established protocols. This role works jointly with other team members within STD, LTD and Risk Management resources.

• Use the most efficient and effective means of proactive outreach to obtain and/or dispense information.
• Coordinate information to and from claimants, departmental managers, physicians, HR, payroll, and other sources.
• Communicate claim status and decisions via telephone and in writing.
• Initiate communications with claimants, physicians, and/or plan holders to obtain information, make assessments, and issue initial claim decisions.
• Prioritize and review new claims to adhere to established departmental productivity goals.
• Meet productivity requirements for handling “fast‑track” disability claims with limited durations.
• Investigate and analyze claim information to determine coverage and benefit eligibility.
• Conduct pre‑existing condition investigations and draft adverse determination letters, when applicable.
• Determine disability by comparing claimant functionality with job requirements.
• Set up claims for initial benefit approval, including physician statements and medical records.
• Follow claim management procedures and identify potential return‑to‑work and job accommodation opportunities when applicable.
• Utilize claim management resources such as MDA (Medical Disability Advisor) and other disability guidelines.
• Work toward returning claimants to active work status.
• Assess claims when other sources of income are received to ensure accurate offsets are applied.
• Recalculate benefits as needed to determine under‑ or over‑payments.

• Demonstrate independent problem‑solving and decision‑making ability.
• Communicate claim decisions and contract language clearly, both verbally and in written correspondence.
• Show strong math aptitude, multitasking ability, and analytical skills.
• Hold a four‑year college degree or equivalent work/education experience.
• Have at least two years of disability claim management experience (STD) or other group insurance experience.
• Possess experience with regulatory and compliance standards related to disability claims.

Alight is an Equal Employment Opportunity employer and does not discriminate based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristic. Alight also takes affirmative action to employ disabled persons and veterans.

Reasonable accommodations are provided to meet accessibility standards when needed.