Claims Specialist

• Provide concierge-level customer service to one of Group Insurance’s largest clients
• Take a consultative approach in guiding and coaching client’s employees through the life cycle of a disability claim
• Deliver world-class service ensuring a more effortless experience for the employee
• Engage Expert Resources to further enhance the claim journey, addressing Behavioral Health and Vocational opportunities
• Interact directly with the Leave team at the client during quarterly virtual meetings
• Interface daily with the client’s Benefits Business Partners
• Seek opportunities to further enhance the claimant experience
• Serve as an ambassador for continuous process improvement within the Concierge Team
• Manage an assigned block of around 75 Long-Term Disability (LTD) and Short-Term Disability (STD) claims
• Oversee a block of complex claims, including those with co-morbidities, behavioral health issues, and self-reported symptoms

Senior Disability Claims Examiner

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

• Create or audit estimates of damages on 1st and 3rd party material damage losses.
• Train, mentor, and provide quality control and technical assistance on claims.
• Ensure accurate evaluation and appropriate claim disposition.

Field Auto Claims Adjuster

• Responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims
• Provide excellent customer service and interact on a regular basis with employees, employers, health care providers and other specialized internal resources
• Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life
• Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge
• Produce objective, clear documentation and technical rationale for all claim determinations
• Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation
• Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business

Associate VB Claims Specialist

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Claims Specialist II

• 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.

Claims Examiner II

• Provide concierge-level customer service to one of Group Insurance’s largest clients
• Take a consultative approach in guiding and coaching our client’s employees through the life cycle of a disability claim
• Deliver world-class service that ensures a more effortless experience for the employee
• Engage Expert Resources to further enhance the claim journey, addressing Behavioral Health and Vocational opportunities within their block of claims
• Interact directly with the Leave team at the client during quarterly virtual meetings
• Interface daily with the client’s Benefits Business Partners
• Seek out opportunities to further enhance the claimant experience
• Serve as an ambassador for continuous process improvement within the Concierge Team
• Oversee a block of complex claims, including those with co-morbidities, behavioral health issues, and self-reported symptoms

See all jobs on JobTailor

Senior Disability Claims Examiner

Senior Claims Adjuster, Large Loss

Field Auto Claims Adjuster

Associate VB Claims Specialist

Claims Specialist II

Claims Examiner II

Senior Disability Claims Examiner