- Investigates claim issues providing resolution within departmental and regulatory guidelines.
- Interprets and administers contract provisions: eligibility and duration.
- Accurately codes all system fields with correct financial, diagnosis and duration information.
- Coordinates with other departments to ensure appropriate claims transition or facilitates timely return to work.
- Document claim updates in the claim database ensuring accuracy.
- Maintaining departmental and policyholder expectations.
- Adheres to compliance, departmental procedures, and Unfair Claims Practice regulations.
- Actively contributes to, and maintains, customer service, quality and performance objectives.
- Proactively engages in departmental trainings to remain current with all claim management practices.
- Responsible for managing Performance Guarantees for assigned clients, and meet targeted metrics.
- Responsible and accountable for maintaining and protecting personal, confidential claimant health information. Must maintain a high level of confidentiality and abide by HIPPA rules and regulations.
- Other responsibilities may be assigned as needed.
- Strong communication skills both written and verbal. Willingness to communicate regularly with claimants, clients, and intercompany colleagues across the organization as needed.
- Desire to work in a fast-paced, energetic environment, in a customer-facing role.
- Ability to act with empathy and care in all interactions on a daily basis. · Demonstrated proficiency in using a personal computer for routine tasks such as email (Outlook), reports (Excel), and general aptitude to learn proprietary disability software platforms.
- Ability to synthesize and analyze data and information.
- Ability to complete assigned tasks and projects in a timely manner, adhering to deadlines.
- Must maintain prompt a nd consistent, predictable attendance, with ability to work assigned daytime shifts 5 days per week. Ability to work overtime as business demands.
- Ability to interact with employees of all levels and clients in an appropriate manner.
- Ability to concentrate and remain focused on tasks throughout the day and think strategically.
- An annual performance bonus for all team members
- Generous 401(k) company match that is immediately vested
- A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
- Multiple options for dental and vision coverage
- Company provided Life & Disability Insurance to ensure financial protection when you need it most
- Family friendly benefits including Paid Parental Leave & Adoption Assistance
- Hybrid work arrangements for eligible roles
- Tuition Reimbursement and Continuing Professional Education
- Paid Time Off, volunteer days, community partnerships, and Employee Assistance Program
- Ability to connect with colleagues around the country through our Employee Resource Group program and our Diversity Equity & Inclusion Council
- Integrity
- Empowerment
- Compassion
- Collaboration
- Fun
EEO Statement