| Disability Claims Examiner III |
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| Also referred to as: Disability Claims Examiner III, Disability Claims Reviewer III |
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| Requirements and Responsibilities |
| Examines and adjudicates short- and long-term disability claims to determine eligibility, benefits, and ongoing entitlement under plan provisions. Reviews medical documentation, occupational information, and financial records to evaluate the validity of claims. Assesses plan definitions, regulatory guidelines, and clinical guidance to make accurate benefit determinations. Coordinates with claimants, physicians, and vocational or clinical resources to obtain and assess relevant information. Calculates benefit amounts, manages offsets, and documents decisions and rationale within the claims system. Ensures compliance with ERISA, state regulations, and company service standards. Requires a bachelor's degree. Typically reports to a manager. Work is generally independent and collaborative in nature. Contributes to moderately complex aspects of a project. Typically requires 4-7 years of related experience. |
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| Similar Jobs: Claims Examiner III, Disability Claims Examiner II, Disability Claims Examiner I, Claims Examiner II, Claims Examiner IV, Claims Examiner I, Disability Claims Manager, Claims Adjuster III - P&C, Claims Clerk III |
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| Level of Education: Disability Claims Examiner III Salaries with an Associate's Degree, Disability Claims Examiner III Salaries with a Bachelor's Degree, Disability Claims Examiner III Salaries with a Master's Degree or MBA, Disability Claims Examiner III Salaries with a JD, MD, PhD or Equivalent |
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| Industries: Business Services, Edu., Gov't. & Nonprofit, Financial Services, Healthcare, Insurance | |
