Disability Adjudicator

About the Company

Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ) is the state’s largest health insurer, serving over 3.8 million members. We are committed to improving the health and well-being of our members and communities. Through innovation and a focus on quality, we strive to make healthcare accessible, affordable, and effective for everyone in New Jersey.

Job Description

We are seeking a dedicated and detail-oriented Disability Adjudicator to join our team in Jersey City, NJ. The successful candidate will be responsible for evaluating and processing disability claims, ensuring compliance with established policies, procedures, and regulatory requirements. This role involves comprehensive review of medical documentation, vocational information, and other relevant data to make fair and accurate determinations regarding eligibility for disability benefits.

Key Responsibilities

• Review and analyze disability claims, including medical records, vocational reports, and other supporting documentation.
• Apply established medical and vocational guidelines to determine claim eligibility and duration.
• Communicate with claimants, healthcare providers, employers, and legal representatives to gather necessary information.
• Prepare clear, concise, and defensible written decisions regarding claim outcomes.
• Maintain accurate and detailed electronic and physical claim files.
• Collaborate with internal teams, including medical directors and vocational specialists, to ensure comprehensive claim assessments.
• Stay informed of changes in disability laws, regulations, and company policies.
• Participate in ongoing training and professional development to enhance adjudication skills.

Required Skills

• Bachelor's degree in a related field (e.g., healthcare administration, social work, business).
• 3+ years of experience in disability claims adjudication or a similar medical/insurance claims processing role.
• Strong analytical and critical thinking skills.
• Excellent written and verbal communication abilities.
• Proficiency in Microsoft Office Suite and claims management software.
• Ability to interpret medical terminology and understand complex medical conditions.
• Demonstrated ability to make objective and consistent decisions based on policy and evidence.

Preferred Qualifications

• Certified Professional in Disability Management (CPDM) or similar certification.
• Experience with state-specific disability programs.
• Knowledge of federal and state disability laws, including ADA and FMLA.
• Bilingual proficiency (English/Spanish).

Perks & Benefits

• Comprehensive health, dental, and vision insurance plans.
• 401(k) retirement plan with company match.
• Paid time off, including vacation, sick leave, and holidays.
• Life and disability insurance.
• Tuition reimbursement program.
• Employee wellness programs and on-site fitness centers.
• Professional development opportunities.

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