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Open nowFirst seen 1 hour ago

LTD Claims Examiner Sr.

Vets Hired791 open roles

Where
NY, United States
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Your applicationOpen nowLTD Claims Examiner Sr.Vets Hired · NY, United States

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The clock on this job

Early applications get read.

12.3% of postings close within 7 days. Measured by our own scanner across the market.

Share of postings closed within
  1. 2.1%1 day
  2. 4.5%3 days
  3. 12.3%7 days
  4. 19.7%14 days
  5. 35.6%30 days
  6. 58.0%60 days
This job: first seen 1 hour ago

The posting

Job Summary

The Senior Long-Term Disability (LTD) Claims Examiner investigates, analyzes, and adjudicates complex long-term disability, voluntary disability, and waiver of premium claims. This role independently makes claim determinations based on policy provisions, available evidence, and applicable regulations. The position also provides subject matter expertise, mentors newer examiners, and supports claim-related investigations, training, and process improvements.

Key Responsibilities

  • Investigate complex disability claims by gathering information from claimants, employers, treating physicians, and other relevant parties.
  • Adjudicate claims accurately and fairly in accordance with policy provisions, internal procedures, and state and federal regulations.
  • Manage a high-volume caseload of approximately 60–80 complex claims independently.
  • Evaluate changes in total disability definitions, including any-occupation provisions.
  • Make independent claim decisions within established approval authority limits.
  • Determine eligibility for waiver of premium benefits under applicable life insurance policies.
  • Conduct detailed pre-existing condition and contestability investigations when necessary.
  • Calculate benefits, including partial disability, residual disability, survivor benefits, and offsets from other income sources.
  • Consult appropriate medical and risk resources and refer claims to the correct risk level.
  • Maintain accurate electronic claim records and supporting documentation.
  • Provide prompt, professional, and accurate customer service while managing competing priorities.
  • Mentor and train newer claims examiners and assist with claim-related projects.
  • Support management with presentations, complaint investigations, regulatory inquiries, and executive complaints.
  • Identify trends, training needs, and opportunities to improve claims processes.

Required Qualifications

  • High school diploma or GED.
  • At least 5 years of experience processing long-term disability claims.
  • Advanced knowledge of claim management, analysis, investigation, and critical thinking.
  • Experience handling confidential and protected information.
  • Thorough knowledge of medical terminology.
  • Strong mathematical and benefit-calculation skills.
  • Ability to manage complex claims independently while meeting productivity and quality standards.
  • Strong communication, customer service, and problem-solving skills.

Preferred Qualifications

  • Associate degree in Business, Finance, Social Work, or Human Resources.
  • Level I LOMA designation.
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