{"@context":"https://schema.org","@type":"JobPosting","directApply":"https://schema.org/False","title":"Claims Specialist - Disability & Leave Benefits","description":"

The work we do has an impact on millions of lives, and you can be a part of it.

We help protect our customers against life’s uncertainties. Regardless of where you work within the company, you’ll be helping provide protection and peace of mind when our customers need it most.

The Claims Specialist works in a team environment to process tasks associated with State-Mandated Disability Claims. This customer-facing position requires excellent written and verbal communication skills to provide top-quality service to claimants and policy-holders. A professional demeanor and a strong desire to help others are essential.

To be successful in this role, the candidate must possess strong critical thinking, organizational, and time management skills, along with a keen attention to detail due to the personal nature of the payouts involved. This role requires experience with and knowledge of State-Mandated Disability Leave, short-term and long-term disability, or FMLA leave administration and claims.

The ideal candidate will have above-average communication and data entry skills, a natural curiosity to learn, and the ability to quickly assimilate new information. They should also be comfortable with technology and adaptable to continuous improvements in both technology and work processes.

Key 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.

Skills and Abilities:

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

Minimum Requirements

High School diploma required
College degree or an equivalent of at least three (3) years of work experience preferred.
1-2 years’ experience in a disability claims environment.
Experience with state mandated disability claims is highly preferred.

Schedule Details

This role operates on a semi-flex 40 hour a week, M-F schedule. All schedules will be approved based on business needs.

Employee Benefits:

We aim to protect our employees' wellbeing through a broad benefits offering. For example, we protect physical wellbeing through health, dental and vision insurance. We protect mental wellbeing through mental health benefits and an employee assistance program. We protect time away from work with a variety of paid time away benefits (e.g., paid time off, paid parental leave, short-term disability, and a cultural observance day). We protect financial wellbeing through contributions to healthcare accounts, a pension plan, and a 401(k) plan with Company matching. All employees are encouraged to protect their overall wellbeing by engaging in ProHealth Rewards, Protective’s platform to improve wellbeing while earning cash rewards.

Eligibility for certain benefits may vary by position in accordance with the terms of the Company’s benefit plans.

Diversity and Inclusion:

At Protective, we are committed to providing an inclusive culture where all employees are able to fully contribute and thrive. Our goal is to grow and develop our people, attract diverse talent and support strong, diverse communities.

We support diversity, equity, and inclusion by working to develop a culture of inclusion and belonging led by leaders who develop potential and embrace all skills and abilities. Our aim is to create an equitable environment for all leaders and employees that will drive performance and impact business strategy. In this way, we can increase overall diversity for leadership roles and pipelines of talent by maturing our hiring practices, robust development opportunities and focus on retention of key talent.

We are proud to be an equal opportunity employer committed to being inclusive and attracting, retaining, and growing the talents of a diverse and inclusive workforce.

Accommodations for Applicants with a Disability:

If you require an accommodation to complete the application and recruitment process due to a disability, please email martina.winston@protective.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application and recruitment process.

Please note that the above email is solely for individuals with disabilities requesting an accommodation. General employment questions should not be sent through this process.

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