Disability Claims Examiner

This position is responsible for reviewing applications, and supporting documents, for disability benefits, and inputting the correct information into the claim processing system to begin the processing of disability benefits. This position is responsible for using manual processing procedures to resolve most pending conditions. It is expected that this position can independently process all but the most complex temporary and total and permanent disability claims.

Direct support will be given on complex disability claims involving trial work, outside wages, workers’ compensation, and T&P initial and subsequent approvals by a Senior Claims Examiner or Analyst. Second level approval is needed by a Senior Claims Examiner or higher for T&P approvals, other manually approved claims, and pre-determined automated claims.

This position provides customer service for members who are applying for, or already approved for, or are being considered for continuing eligibility for disability benefits.

• Review and accurately input all information from all IMRF forms and supporting documentation submitted by IMRF members.
• Contact other IMRF departments to obtain information and request corrections in an effort to resolve most internal conditions preventing payment of benefits.
• Contact employers, employees, physicians, hospitals, Social Security and worker’s compensation carriers to obtain information necessary to determine eligibility, duration and amount of most disability benefits.
• Review medical records to determine extent of disability for temporary / total and permanent claims, and to make recommendations concerning the application of pre-existing condition language.
• Approve members for temporary disability benefits and make recommendations concerning member’s eligibility for Total and Permanent disability.
• Provide customer service to employers, employees, medical providers, and other IMRF departments by answering questions concerning procedures and benefits, either in writing or by telephone.
• Maintain a work in progress that meets the service goals established by the Disability Manager.
• Provide detailed information to vested members concerning retirement benefits, including a comparison between IMRF benefits available to disabled members and benefits available to retired members. This requires the examiner to do a service audit.
• Analyze the initial claim application and supporting documents to determine what additional requests for information must be made to obtain the necessary level of documentation to approve or deny the application for disability benefits.
• Establish follow-up dates and methods for each on‑going claim assigned to them.
• Write letters to the IMRF medical consultants that summarize the medical and non‑medical facts of disability cases.
• Other duties may be assigned.

This job has no supervisory responsibilities.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Associate degree or two years related experience and/or on‑the‑job training; or equivalent combination of education and experience equaling two years.

Ability to read, analyze and interpret benefit claim forms, supporting medical documents, and written procedures. Ability to write business correspondence. Ability to effectively communicate with both internal and external customers to respond to questions and obtain information.

Ability to work with mathematical concepts such as benefit calculations, including use of the IMRF benefits formulas, and wage and service information. Ability to apply concepts such as fractions, percentages, ratios and proportions to practical situations.

Ability to analyze/solve practical problems and deal with a variety of concrete variables in situations where standard procedures and calculations…