Senior Claims Specialist – Short Term Disability
Job Description:
• Manage a diverse and often complex caseload of STD (Short Term Disability) claims from initial intake through resolution, ensuring timely, fair, and accurate decisions using sound judgment and adherence to policy provisions.
• Collaborate with clinical and vocational partners to develop effective RTW strategies and determine appropriate benefit eligibility and durations.
• Serve as a subject matter expert on STD claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements.
• Leverage a deep understanding of disability contract provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements (e.g., FMLA, ERISA, HIPAA).
• Ensure detailed and accurate documentation of all decisions and interactions, and communicate clearly with claimants, employers, and internal stakeholders.
• Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team.
• Collaborate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to deliver a coordinated and compliant claims experience.
• Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives.
• Demonstrate agility in adapting to changing priorities, business needs, and regulatory requirements.
• Maintain a high level of confidentiality, professionalism, and integrity in all claim-related activities.
Requirements:
• College degree or equivalent experience preferred.
• Minimum 5 years of experience handling Short Term Disability claims
• Strong understanding of Short term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
• Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
• Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically.
• Demonstrated problem-solving and analytical skills with a customer-first mindset.
• Highly organized and detail-oriented with the ability to manage competing priorities.
• Proven ability to mentor peers and support a collaborative team environment.
• Proficiency with claims administration platforms and workflow/documentation tools.
• Demonstrated ability to work independently and exercise sound judgment.
• Growth mindset with a commitment to continuous learning and improvement.
• Strong time management and the ability to thrive in a fast-paced, evolving environment.
• Experience supporting cross-functional or enterprise initiatives and change management efforts.
Benefits:
• Your Benefits Start Day 1
• Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
• Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
• Paid Parental Leave as well as an Adoption Assistance Program
• Competitive 401k savings plan with company match and an additional contribution regardless of participation
Apply Now
Apply Now
• Manage a diverse and often complex caseload of STD (Short Term Disability) claims from initial intake through resolution, ensuring timely, fair, and accurate decisions using sound judgment and adherence to policy provisions.
• Collaborate with clinical and vocational partners to develop effective RTW strategies and determine appropriate benefit eligibility and durations.
• Serve as a subject matter expert on STD claim practices, consulting on best practices and contributing to the design and refinement of internal procedures, workflows, and system requirements.
• Leverage a deep understanding of disability contract provisions, exclusions, riders, waivers, and applicable regulatory and statutory requirements (e.g., FMLA, ERISA, HIPAA).
• Ensure detailed and accurate documentation of all decisions and interactions, and communicate clearly with claimants, employers, and internal stakeholders.
• Mentor and support onboarding of new team members; share expertise and foster knowledge growth within the team.
• Collaborate cross-functionally with Compliance, Legal, Intake/Admin, Clinical and Vocational Services, and other business units to deliver a coordinated and compliant claims experience.
• Proactively identify process gaps or opportunities and contribute to continuous improvement efforts and enterprise initiatives.
• Demonstrate agility in adapting to changing priorities, business needs, and regulatory requirements.
• Maintain a high level of confidentiality, professionalism, and integrity in all claim-related activities.
Requirements:
• College degree or equivalent experience preferred.
• Minimum 5 years of experience handling Short Term Disability claims
• Strong understanding of Short term Disability claim adjudication and relevant federal/state regulations (e.g., FMLA, ERISA, HIPAA, ADA).
• Experience partnering with clinical/vocational professionals to support RTW efforts and complex decisioning.
• Effective verbal and written communication skills with the ability to explain complex decisions clearly and empathetically.
• Demonstrated problem-solving and analytical skills with a customer-first mindset.
• Highly organized and detail-oriented with the ability to manage competing priorities.
• Proven ability to mentor peers and support a collaborative team environment.
• Proficiency with claims administration platforms and workflow/documentation tools.
• Demonstrated ability to work independently and exercise sound judgment.
• Growth mindset with a commitment to continuous learning and improvement.
• Strong time management and the ability to thrive in a fast-paced, evolving environment.
• Experience supporting cross-functional or enterprise initiatives and change management efforts.
Benefits:
• Your Benefits Start Day 1
• Prioritization of your health and well-being including Medical, Dental, Vision, and Wellbeing Reimbursement Account that can be used on yourself or your eligible dependents
• Generous paid time off options including: Paid Time Off, Holiday Schedules, and Financial Planning Time Off
• Paid Parental Leave as well as an Adoption Assistance Program
• Competitive 401k savings plan with company match and an additional contribution regardless of participation
Apply Now
Apply Now