Claims Examiner II

RSLI LTD

full-time

Posted on:

Location Type: Hybrid

Location: South Portland • Maine • United States

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Salary

💰 $23 - $29 per hour

About the role

  • Obtains and analyzes information to make claim decisions and payments of Short Term Disability (STD) claims.
  • Research Applies knowledge of disability products, policies and contracts.
  • Interprets and applies contract/policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements.
  • Utilizes reference materials and tools regarding medical, vocational and disability issues to identify and evaluate claim information in a fair and objective manner.
  • Fully investigates all relevant claim issues.
  • Provides payment or denials promptly and in full compliance with department procedures and regulations.
  • Determine and implement appropriate return to work strategy for assigned cases.
  • Communicates with claimants, policyholders, and physicians to resolve investigations concerns.
  • Collaborates with team members and management in identifying and implementing improvement opportunities.
  • Manages appropriate volumes, consistently meeting turnaround times, high activity levels, and quality focus on timely claim activities.
  • Serves as a subject matter expert within team, provides some mentor support for newer examiners to assist in their development.

Requirements

  • 2 years STD claims examiner experience (Short Term Disability)
  • Associates Degree, Bachelors Preferred
  • Promptly acknowledges customers' needs, both internal and external.
  • Ensures customers' needs are handled in a timely and appropriate manner.
  • Creates a positive impression.
  • Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback.
  • Communicate/respond appropriately to varied audiences/tasks.
  • Exhibits teamwork, honors commitments.
  • Anticipates, analyzes and defines problems.
  • Develops and assesses alternative solutions as necessary.
  • Makes appropriate decisions in a timely manner.
  • Analyzes impact of decisions.
  • Work is accomplished quickly and accurately.
  • Takes responsibility for actions.
  • Prioritizes work effectively and uses time efficiently.
  • Accomplishes goals and objectives.
  • Makes/fulfills commitments.
  • Consistently works independently, meets deadlines, and accepts responsibility for his/her actions.
  • Adheres to all attendance requirements.
  • Prompt, well prepared and ready to contribute.
  • Level I LOMA Designation Preferred
  • Ability to Travel: None
Benefits
  • 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 – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays.
  • As you grow with us, your PTO may increase based on your level within the company and years of service.
  • Volunteer days, community partnerships, and Employee Assistance Program
  • Ability to connect with colleagues around the country through our Employee Resource Group program
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
Short Term Disability claimsclaim analysiscontract interpretationpolicy evaluationinvestigation techniquesreturn to work strategydecision makingproblem analysissolution assessmenttime management
Soft Skills
interpersonal skillsactive listeningteamworkcustomer servicecommunicationresponsibilitycommitmentindependenceadaptabilityorganizational skills
Certifications
Associates DegreeBachelors DegreeLevel I LOMA Designation