Claims Specialist - Disability & Leave Benefits

Summary

Join Protective and be a part of a team that makes a difference in millions of lives by providing protection and peace of mind to customers. As a Claims Specialist, you will process State-Mandated Disability Claims, requiring excellent communication and a professional demeanor. Success in this role demands strong critical thinking, organizational, and time management skills, along with knowledge of State-Mandated Disability Leave, short-term and long-term disability, or FMLA leave administration and claims. The ideal candidate possesses above-average communication and data entry skills, is adaptable to new technologies, and thrives in a team environment. This position offers a semi-flex 40-hour work week and a competitive salary.

Requirements

• Strong customer service and communication skills
• Attention to detail and organizational skills
• Technological aptitude and adaptability
• Teamwork and problem-solving abilities
• Knowledge of federal and state laws on leaves of absence
• Ability to evaluate and process disability and leave claims
• Proficiency in Microsoft Excel and Word
• High School diploma required
• 1-2 years’ experience in a disability claims environment

Responsibilities

• Understand and appropriately apply department processes and regulatory policies
• Manage new, continuous, and/or periodic claims by continually reviewing and prioritizing incoming mail and correspondence to ensure mandated turnaround times are achieved
• Perform outreach to claimants, policyholders, and healthcare providers via telephone and/or in writing to obtain information needed for initial and ongoing claim management
• Conduct reviews of claimant, employer, and medical information, along with other relevant information, to accurately and timely determine benefit eligibility, claim duration, and benefits payable (including the proper application of taxes)
• Escalate complex claim situations to Subject Matter Expert and/or Claims Supervisor
• Accurately and thoroughly document claim file actions and conversations
• Achieve, and preferably exceed, departmental hourly/daily claim (task) output productivity goals
• Make accurate determinations to approve, pend, or deny claims consistent with department processes on all assigned claims
• Achieve, and preferably exceed, departmental financial and statistical quality standards. Review, process, and respond to Quality Audits/Audit Correspondence
• Promote a positive customer experience through prompt, accurate, and courteous services to both internal and external customers
• Contribute to a positive work environment while working with various other departments to ensure achievement of departmental and corporate goals and objectives
• Contribute to the department’s various project work and assignments, as needed

Preferred Qualifications

• College degree or an equivalent of at least three (3) years of work experience preferred
• Experience with state mandated disability claims is highly preferred

Benefits

• Comprehensive health, dental and vision insurance
• Mental health benefits and an employee assistance program
• A variety of paid time away benefits ( e.g. , paid time off, paid parental leave, short-term disability, and a cultural observance day)
• Contributions to healthcare accounts
• A pension plan
• A 401(k) plan with Company matching
• ProHealth Rewards, Protective’s platform to improve wellbeing while earning cash rewards