A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
20 hours per week, Monday thru Friday between 7:00AM - 5:00
PM Contract Length:
12-months, opportunity for extension and/or conversion pending performance, attendance, and business need
Target Start Date:
08/24/2026 (pending completion of new hire onboarding)
Job Description:
We are seeking an experienced LTD Claims Consultant to evaluate Long Term Disability (LTD) and Individual Disability Insurance (IDI) claims in accordance with policy provisions, regulatory requirements, and established service standards. This role requires strong analytical and critical thinking skills, sound decision-making abilities, and a customer-focused approach. The successful candidate will independently manage a caseload of moderately complex claims, ensuring timely, accurate, and well-supported claim decisions while delivering exceptional service to claimants and business partners.
Responsibilities include:
Manage an assigned caseload of moderately complex LTD claims, including pending, active, ongoing, and appeal reviews. Conduct timely, balanced, and accurate claim evaluations in compliance with policy provisions, regulatory guidelines, and internal service standards. Communicate proactively with claimants and their representatives via telephone to gather medical, occupational, financial, and other relevant claim information. Document all claim-related communications thoroughly, accurately, and professionally within claim management systems. Build and maintain effective relationships with claimants, customers, attorneys, brokers, family members, and other stakeholders throughout the claims process. Analyze medical, vocational, occupational, and financial information to determine claim eligibility and identify additional information needed for claim decisions. Collaborate with physicians, attorneys, vocational consultants, clinical specialists, and other internal and external resources to support comprehensive claim evaluations. Investigate and reconcile inconsistencies in claim information and partner with Fraud, Waste, and Abuse teams when necessary. Calculate monthly disability benefits, including Social Security offsets, rehabilitation return-to-work benefits, and other non-routine payments. Prepare detailed written correspondence communicating claim status, requests for information, and claim determinations. Address and resolve escalated customer concerns in a timely, professional, and empathetic manner. Identify and refer matters requiring involvement from appeals, complaints, or litigation support teams. Continuously demonstrate sound judgment, strong inventory management, and adherence to key performance indicators and quality standards.
Skills required include:
3+ years of LTD/IDI Insurance Claims experience (required) Bachelor's degree required. Strong decision-making, critical thinking, and analytical skills. Excellent verbal and written communication skills. Proven customer service and relationship management abilities. Ability to handle complex claims and apply sound judgment. Strong organizational, time management, and problem-solving skills. Experience working in a fast-paced, deadline-driven environment. Able to work from home; this requires access to high speed Wi-Fi/cable/DSL internet, a dedicated area to work with minimal interruption, and a smart phone. #TMCA
