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PLADS STD Case Manager (Claims Specialist)

The Company:  true
The Location: 

Remote, US

The Division: 
Job Id:  3501

Multiple Roles Available

 

Job Summary

 

Makes timely, accurate, and customer-focused Short-Term Disability and/or Absence Management claim decisions. Proactively engages clinical, vocational, employer, financial, and other informational internal and external sources to gather relevant data and compares it to the applicable contract/administrative agreement and procedural documents. Conducts an analysis of data and engage peers and management as appropriate. Communicates verbally and in writing an accurate and comprehensive decision. Maintains performance at or above departmental metrics.

 

Principal Duties & Responsibilities

 

 • Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible

 

• Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claims team operational metrics

 

• Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimant's and employer's trust and confidence; anticipates customer’s needs and takes action as appropriate

 

• Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence.

 

• Performs other related duties as required.

 

 

Education & Experience Required

 

  • Minimum Required High School Diploma
  • Minimum Required 0-2 years of job-related claims experience
  •  Minimum Required Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services

 

Education & Experience Preferred

 

  • Preferred Bachelor's Degree In healthcare or a related field

 

Or an equivalent combination of education and experience

 

 

Job Knowledge & Skills

 

• Familiarity with disability claim management concepts

 

• Good understanding of medical terminology/pathology/anatomy

 

• Articulate verbal and writing skills, decision making, meeting deadlines, working with confidential information

 

• Moderate skills with Microsoft Office and other software applications

 

• Customer service skills

 

 • Stress tolerance

 

• Math skills

 

• Ability to multi-task and prioritize

 

• Have a high level of attention to detail

 

• Work under pressure

 

• Confidence to make claim decisions

 

• Results-driven

 

• High attention to departmental/company procedures/practices

 

 

Competencies

 

  • Acting with Integrity - 
  • Communicating Effectively -
  • Pursuing Self-Development 
  • Serving Customers -
  • Supporting Change - 
  • Supporting Organizational Goals -
  • Working with Diverse Populations -

 


Nearest Major Market: Eugene