Sr. Insurance Associate

Basic Function
Responsible for structuring Long-Term Disability (LTD) claims based on claim receipt date. Support the claim adjudication (claim specialist) team with the initial claim setup in accordance with the plan provisions, identify potential recurrent claims, and utilize several systems to verify coverage. Determine LTD eligibility. Prepare and send acknowledgment in 5-days to EE/ER. Respond to questions from EE & ER over emails. The position is expected to structure LTD – stand-alone claims, bridge claim from STD via various intake modes for large, mid large & small market. Interact with claim specialist, claim support specialist (QA), Claims Manager (stateside supervisors), EE, ER through emails/systems.
Essential Functions
Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
Analyze and research all discrepancies.
Research & Investigate and resolve outstanding items
Determine eligibility and applicable plan provisions while meeting timeliness goals
Clear and accurate written and verbal communication (Scripted and Templatized) with employee, employer & stateside resources by email
Establish action plans for each file to bring claims to resolution
Utilize internal and external specialty resources to maximize impact on each claim file
Utilize Intellis and ACS (SIR) to update and maintain accurate data record
Use PC programs to increase productivity and performance
Ensure that the assigned targets are met in accordance with SLA and Internal standards
Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and meeting key measures.
Ensure adherence to established attendance schedules
Sedentary work – involves sitting most of the time
Close visual acuity - viewing a computer terminal and extensive reading
Talking – expressing or exchanging ideas by means of the spoken word.
AI Fluency - Working knowledge of Microsoft Copilot.
Any other essential function that may occur from time to time as directed by the Supervisor.
Primary Internal Interactions
AM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support.
Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance.
Subject Matter Expert for the purpose of work thread related issues and escalated transactions.
QCA for the purpose of feedback and audit.
Trainers for the purpose of Pre-process and Process training.
Primary External Interactions
Employees (EE), Employers (ER), Claims specialist & other Stateside Teams on emails
SME / Trainers at the client end for training.
Organizational Relationships
Reports To: Assistant Manager, Long Term Disability Process Supervises: 0
Skills
Technical Skills
Good computer navigation skills
Good keyboarding speed
Good knowledge of complete MS Office suite
Process Specific Skills
Knowledge about the Insurance industry in US
Knowledge about US Culture
Knowledge of Insurance principles
Soft Skills (Minimum)
Communication skills – should be able to read, interpret business documents. Good oral/written communication
Proficiency in English – Spoken and Written
Analytical and interpersonal skills
Escalate issues if required
Data gathering ability/ Eye for detail
Team work/ Managing Self / Adaptability
Ability to work successfully in production driven environment
Adaptability to change
Ability to work on routine/standardized transactions
Soft Skills (Desired)
Self disciplined and result oriented
Ability to multi task
Ability to work effectively as part of a team
Knowledge of Medical Terminology (preferred but not compulsory)

Work arrangement
Hybrid