Jennifer Mullett

· Independently manage a full caseload of complex claims, ensuring appropriate sign offs are obtained. This may include responsibility for complex claims and accounts. Caseload size may vary by product(s).

· Independently build action plans, analyze outcomes and render a determination in accordance with our quality and service guidelines.

· Independently evaluate and analyze all information in claim files to determine appropriate action steps and adjudication of claims.

· Evaluate the need for and ensure timely referrals to others as appropriate.

· Undertake a timely, accurate claims review, initiate appropriate claim validation activities, and recommend either initial approval of benefits or denial of the claim. Can effectively articulate rationale for action.

· Display a thorough knowledge of products, policies/procedures, contracts and medical and vocational issues, financial and legal issues.

· Demonstrate a strong understanding of the applicable contract/policy definitions and relevant provisions, clauses, exclusions, riders and waivers as well as regulatory and statutory requirements for claim products administered.

· Apply contract/policy knowledge and analyze technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions and appropriate payee.

· Problem solve with an independent demonstration of analytical/ logical thinking, recognizing multiple connections, optimizing results by choosing the best strategies resulting in fair and objective claim decisions

· Verify on-going liability and develop strategies for return to work opportunities as appropriate. Demonstrate strong claim validation and return to work techniques, where applicable.

· Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively verbally communicate determinations.

· Demonstrate strong knowledge and effectively utilize a broad spectrum of resources, materials and tools regarding contractual, medical, vocational, disability and RTW strategies, as required.

· Strong knowledge of the applicable claims system(s).

· Coordinate and share information with other products as appropriate.

· Provide timely and excellent customer service by paying appropriate claims promptly and quickly responding to all inquiries.

· Maintain expected service and quality standards on all assigned claims.

· Protects the Company against extra-contractual liabilities by following established guidelines and regulations.

· May perform other duties as assigned.