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Claims Processing Specialist
2 months ago
We are looking for a meticulous and committed Claims Processing Specialist to oversee a varied portfolio of leave compensation and disability claims. In this role, you will be tasked with managing disability and leave compensation claims for various clients, ensuring compliance with client policies and plan specifications. Your goal will be to process claims with precision and efficiency while upholding exceptional standards of customer service and documentation.
Position Title: Claims Processing Specialist
Reports To: Operations Manager
FLSA Status: Non-Exempt
Embrace the Gold Standard of service delivery while prioritizing claim success.
Key Responsibilities and Essential Functions
- Manage a comprehensive workload of disability and/or leave compensation claims for multiple clients (8+) in accordance with client policies and plan specifications. Claims management includes, but is not limited to:
- Verifying plan eligibility and determining claim payability;
- Assessing medical documentation and liaising with healthcare providers;
- Initiating/approving/extending/closing claims;
- Drafting correspondence to employees regarding disability benefits, including denial notifications;
- Calculating benefit reductions;
- Maintaining high-quality employee disability claim files following established standards and naming conventions;
- Delivering outstanding customer service by processing payments accurately and promptly.
- Collaborate with Employee Success team members by addressing inquiries regarding pay eligibility, required documentation, client policies, and benefits.
- Engage in regular communication with Employee Success team members, Team Leads, employees, and client representatives to ensure accurate coordination between client leave compensation and other income replacement benefits.
- Conduct weekly self-audits; submit claim status reports to the manager with explanations for any discrepancies.
- Be prepared to take on additional responsibilities on short notice as business needs arise.
- When necessary, coordinate between short-term disability insurance providers, workers' compensation insurance carriers, and employees.
- Participate in client meetings, company-wide off-site meetings, and training sessions, which may involve occasional travel.
- Be available to support multiple accounts.
- Perform other duties as assigned to meet business requirements.
- Expected to work 40 hours per week.
- Expected to report to the office five days a week; after six months, the possibility of a hybrid schedule will be evaluated based on performance. Hybrid work arrangements are subject to change based on performance and business needs.
- Perform all duties in the office during regular business hours: Monday to Friday, 8am to 5pm (EST).
Qualifications:
- A Bachelor's degree in Business Administration, Human Resources, Healthcare Administration, Finance, Accounting, or a related field is required.
- A minimum of 1 year of relevant experience in claims administration, human resources, healthcare administration, or finance/accounting. Experience in the insurance sector is advantageous.
- Proficient typing skills and strong knowledge of MS Excel and MS Word.
- Consistently focused on delivering excellent customer service.
- Ability to prioritize tasks effectively and concentrate on the most critical ones.
- Strong communication skills to interact effectively with colleagues, leadership, clients, and employees.
- Possess a system for tracking work to ensure timely and accurate completion.
- Ability to quickly identify and resolve problems efficiently.
- Willingness to learn and embrace new challenges.
- Proactive in understanding the rationale behind processes.
- Open to feedback and committed to continuous improvement.
- Effective time management, punctuality, and a focus on finding better methods for task completion.
- Helpful, respectful, approachable, and team-oriented, fostering strong working relationships and contributing to a positive workplace culture.
- Excellent follow-through and practical judgment.
- Exceptional attention to detail.
- Strong organizational, quantitative, and verbal/written communication skills.
- Adept at comprehending a variety of informational documents, including disability plan documents and client leave policies.
- Capable of interpreting various reference materials, including administrative manuals, personnel policies, and state and federal regulations.
- Ability to stay informed about changes in laws, policies, methods, and procedures as they relate to clients.
To learn more about Larkin Benefit Administrators, our culture, and the generous benefits we offer, please visit our company website.
This job description is intended to convey the general nature and level of work being performed; it is not an exhaustive list of all responsibilities, duties, and skills required for the position.
At Larkin Benefit Administrators, we are dedicated to fostering an inclusive and diverse work environment. We proudly uphold equal opportunity employment and do not discriminate against any employee or applicant based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristics. We believe that diverse perspectives and experiences drive innovation and success. All qualified candidates are encouraged to apply.
The salary for this position is determined based on several factors, including relevant skills and experience, industry knowledge, market rates, geographic location, and internal equity. We strive for transparency and fairness in our compensation practices and welcome any questions during the hiring process.
Compensation details: Yearly Salary
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