Short Term Disability Claims Specialist
Job Posting for Short Term Disability Claims Specialist at Software Guidance & Assistance, Inc. (SGA, Inc.)
Software Guidance & Assistance, Inc., (SGA), is searching for a Short Term Disability Claims Specialist for a CONTRACT assignment with one of our premier Insurance Services clients in Oriskany, NY.
Responsibilities :
SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company EEO page to request an accommodation or assistance regarding our policy.
Responsibilities :
- Manages overall block of assigned claims in accordance to Operational Efficiency goals, Demonstrate Service Delivery and Customer Satisfaction goals, including prioritizing actions, appropriately utilizing resources timely, maintain data integrity through accurate benefit decision and payment
- Executes individual claim action plans, serves as point of contact for the claimant and provides a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication, and makes claim decisions. Proactively updates partners that may be working with the claimant when key events are being considered or have occurred. (Closure, RTW, etc.)
- Accountable approves key decisions made by team member(s) within authority limit including Financial accuracy of coding Claims System including accurate claim Benefit Amount/Salary and appropriately investigates other income/offsets in accordance with Customer's plan/policy
- Actively demonstrate key behaviors - Active and engaged participant in regularly scheduled 1:1s and daily team huddles, Promotes and participate in a work environment including successfully working with others to achieve desired results; contributes to team goals, projects; exchanges ideas, opinions, develops positive working relationships.
- Performs other related duties as assigned or required
- High School Diploma
- 1-2 Years in short-term disability claims experience
- Computer literacy - Microsoft Word and Excel in particular
- Strong communication skills, both written and oral.
- A comprehensive understanding of the disability contractual provisions, especially the definition of disability.
- Strong communication skills, including the ability to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim.
- Basic knowledge of medical conditions, treatments, prognosis
- Critical-thinking skills
- Ability to give and receive feedback to/from partners
- Strategic-thinking skills and the ability to apply judgment and decision-making based on strategy
- Prioritization skills. Ability to balance quantity and quality.
- Associate Degree
- 2 plus years of claims management experience preferably in Healthcare field
- Proficient in Microsoft Word/Excel
- Some college or degree preferred.
- Prior STD and/or Family Medical Leave Act claims knowledge preferred.
- Strong communication skills, both written and oral.
- Demonstrated critical thinking in activities requiring analysis, investigation, and/or planning.
- Strong problem solving and analytical skills.
- Ability to work independently.
- Ability to multitask, comfortable working with multiple priorities in a changing environment.
- Ability to prioritize and maintain quality
SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company EEO page to request an accommodation or assistance regarding our policy.
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