Description:
Job Title: Claims Associate
Reports To: Operations Manager
FLSA Status: Non-Exempt
Learn about Gold Standard service delivery while focusing primarily on claim success.
Job Duties and Essential Functions:
- Administer a full workload of disability and/or leave pay claims for multiple (8+) clients per client policies and plan guidelines. Claims administration includes, but is not limited to:
- Confirming plan eligibility and whether a claim is payable;
- Reviewing medical documentation and communicating with healthcare providers;
- Opening/approving/extending/closing claims;
- Drafting letters to be sent to employees regarding disability benefits, including denial letters;
- Calculating reductions;
- Maintaining high-quality employee disability claim files according to set standards and naming conventions; and
- Providing excellent customer service by processing payments in a thorough and timely manner.
- Collaborate with Employee Success team members by answering questions regarding pay eligibility, documentation required, client policies, and benefits.
- Communicate regularly with Employee Success team members, Team Leads, employees, and client contacts to ensure the accurate coordination between client leave compensation pay and other income replacement benefits.
- Weekly self-audits; claim status reports sent to manager with explanation of any outliers.
- Able to take on additional work with short notice (e.g. client needs to be taken over on short notice due to business needs).
- When required, coordinate between short-term disability insurance carriers, worker's compensation insurance providers, and the employee.
- Participate in client meetings, company-wide off-site meetings, and training programs which may require some infrequent travel.
- Available to back up multiple accounts.
- Perform other duties as assigned in order to meet business needs.
- Expected to work 40 hours per week.
- Expected to report to the office two times per month as directed by manager.
Perform above duties in the office between regular business hours:
- Roseville, CA office location: Monday to Friday, 8am to 5pm (PST)
- Atlanta, GA office location: Monday to Friday, 8am to 5pm (EST)
- Phoenix, AZ office location: Monday to Friday, 8am to 5pm (MST)
Requirements:
- A four-year college degree or a professional certification in a similar or related field.
- Proficient typing and strong knowledge of MS Excel and MS Word.
- Always focused on providing excellent customer service.
- Ability to prioritize tasks and focus on the most important ones.
- Ability to communicate effectively with colleagues, leadership, clients, and employees.
- Have a system for keeping track of work to ensure that the work is done on time and accurately.
- Ability to identify and solve problems quickly and efficiently.
- Willing to learn and take on new challenges.
- Takes the initiative to understand the why behind things.
- Receptive to feedback and embraces continuous improvement.
- Planning ahead, managing time well, being on time, and thinking of better ways to do things.
- Being helpful, respectful, approachable and team-oriented, building strong working relationships and contributing to a positive work environment.
- Excellent follow through and common sense.
- Excellent attention to detail.
- Strong organizational, quantitative, and verbal/written communications skills.
- Ability to comprehend a variety of informational documents including, but not limited to, disability plan documents and client leave policies.
- Ability to comprehend and interpret a variety of reference books and manuals including administrative manual, personnel policies, and state and federal regulations.
- Ability to keep abreast of any changes in law, policy, methods, procedures, etc. as they pertain to clients.
Compensation details: 0 Yearly Salary
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