Job Location: Virtual (AFTER TRAINING), but must be in commutable distance from Tamps, FL or Bloomfield, CT TRAINING WILL BE IN PERSON. Role Value Proposition: Claim owner and decision-maker. Responsible for administering claims within contractual provisions and internal /external guidelines. Establishes a relationship with claimants to understand their perspective on their disability. Using that perspective and other information, identifies the claimant’s functional capacity and leverages that capacity within the context of the contract to support and encourages return to work as appropriate. Key Responsibilities:
Manages overall STD block of claims and possible companion claims to include Statutory plans, Federal, Company, State and other Leave types as required by our group customers or other Federal, State, Local laws
Creates and executes individual claim action plans, serves as point of contact for the claimant and provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication, and makes claim decisions. Proactively communicates/updates to partners that may be working with the claimant when key events are being considered or have occurred (Closure, RTW, etc.)
Meet and Exceed Operational Efficiency goals, Demonstrate Service Delivery and Customer Satisfaction goals, including prioritizing actions, appropriately utilizing resources timely, maintain data integrity through accurate benefit decision and payment
Accountable for accurate financial decisions on block of claims with financial base benefit amount up to $8000 per week per claim decisions made in accordance with Customer provisions
Performs other related duties as assigned or required
Essential Business Experience and Key Behaviors, Required:
Understands value in building rapport and develops positive working relationships
Motivated by their interactions with others
Quickly grasps information and efficiently solves verbal challenges with strategic thinking
Communicates complex verbal and written concepts with ease
Pays close attention to details, and accounts for details that may be overlooked
Professionally demonstrate empathy to others
Provide original insights on familiar subjects
Balances task work while adapting to change and exploring new innovative ideas
Ability to prioritize and maintain quality
High School Diploma
Key Competencies, Qualifications and Skills, Preferred:
Associate Degree or higher
2 plus years of claims management experience preferably in Healthcare field
Proficient with Microsoft office software
Prior STD and Family Medical Leave Act claims knowledge
Ability to work independently
An understanding of disability contractual provisions