Disability Claims Examiner II (Bilingual Preferred, Remote)

Job Description

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) 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. 
• Work independently as well as within a team structure.
 

What You’ll Need to Succeed:

o 2-3 year minimum of prior Long Term Disability Claim Management or highly relevant experience required
o Exceptional customer service skills 
o Proven skills in positive and effective interaction with challenging customers 
o Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English)
o Excellent organizational and time management skills with ability to multitask and prioritize deadlines. 
o Ability to manage multiple and changing priorities.
o Detail oriented; able to analyze and research contract information.
o Demonstrated ability to operate with a sense of urgency. 
o Experience in effectively meeting/exceeding individual professional expectations and team goals. 
o Demonstrated analytical and math skills. 
o Ability to exercise critical thinking skills, risk management skills and sound judgment. 
o Ability to adapt, problem solve quickly and communicate effective solutions. 
o High level of flexibility to adapt to the changing needs of the organization. 
o Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
o Continuous improvement mindset 
o A commitment to support a work environment that fosters Diversity and Inclusion
o Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.