Senior Disability Claims Examiner
Prudential is a company of smart, ambitious professionals working together across a multitude of disciplines. Together, we are building a better financial future for our customers and our communities around the globe. At Prudential, we understand that a company is only as good as its people. This simple fact is central to all that we do.
The Team
You will be part of the Long-Term Disability (LTD) Claims team which is part of our Group Insurance Business. We have Long-Term Disability teams based out of New Jersey, Maine, and Arizona as well as fully remote teams.
The Role
The Long-Term Disability (LTD) Senior Disability Claims Examiner is responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. As a claim manager you will partner with medical and vocational resources to evaluate disability and support return to work goals. Additional responsibilities include:
Deliver an exceptional customer experience that serves to differentiate Prudential from our competitors and ensures that customer commitments and deliverables are achieved.
Communication via telephone, email, and text with employees, employers, attorneys, and others.
Review and interpret medical records, utilizing resources as appropriate.
Complete financial calculations
Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered.
Apply contract/policy provisions to ensure accurate eligibility and liability decisions.
Demonstrate and apply analytical and critical thinking skills.
Verify on-going liability and develop strategies for return-to-work opportunities as appropriate.
Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication.
Leverage a broad spectrum of resources, materials, and tools to render claims decisions.
Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards.
Work within a fast-paced environment, with tight deadlines and the ability to balance multiple priorities.
Provide technical direction and/or mentorship to other claims personnel as needed.
Work independently as well as within a team structure.
What you’ll need to succeed:
4+ years of experience in Long Term Disability Claim Management required
Exceptional customer service skills
Ability to solve complex claim scenarios with minimal mentorship
Excellent claim/risk management skills and technical knowledge in contract interpretation and administration
Proven skills in positive and effective interaction with challenging customers
Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English)
Excellent organizational and time management skills with ability to multitask and prioritize deadlines.
Ability to manage multiple and changing priorities.
Detail oriented; able to analyze and research contract information.
Demonstrated ability to operate with a sense of urgency.
Experience in effectively meeting/exceeding individual professional expectations and team goals.
Demonstrated analytical and math skills.
Ability to exercise critical thinking skills, risk management skills and sound judgment.
Ability to adapt, problem solve quickly and communicate effective solutions.
High level of flexibility to adapt to the changing needs of the organization.
Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
Continuous improvement mindset
A commitment to support a work environment that fosters Diversity and Inclusion
Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.
