STD Claims Examiner II making accurate claim decisions for Short Term Disability claims. Collaborating with team members in a hybrid work environment from South Portland, ME.
About the role
- Bilingual Disability Claims Specialist in Group Insurance managing claims, coordinating with stakeholders, and ensuring compliance. Working across diverse fields to support recovery and client relationships.
Responsibilities
- Adjudication: Fairly and objectively assess disability claims using a multidisciplinary approach, prioritizing critical tasks while ensuring compliance with policies, procedures, and regulatory requirements.
- Communication: Deliver clear, empathetic, and timely communication to clients, employers, and partners, particularly when handling sensitive decisions such as claim denials.
- Critical Analysis & Decision Making: Use critical thinking to make informed, timely decisions based on thorough evaluations of claim details.
- Negotiation and Resolution: Clearly articulate claim decisions in writing and verbally to address concerns, foster mutual respect, and manage escalations effectively.
- Claim Management: Efficiently and accurately manage a high-volume caseload, calculate benefit payments, and implement return-to-work strategies to support claimants’ recovery.
- Stakeholder Building: Cultivate strong relationships with key stakeholders and claimants to facilitate recovery and successful return-to-work outcomes.
- Cross-Functional Collaboration: Collaborate seamlessly with medical, legal, and client service professionals to ensure consistency and drive positive results throughout the claims process.
- High Sustained Concentration and Mental Processing: Maintain focus and mental acuity to effectively handle complex cases and high-volume workloads.
Requirements
- Must-have Post-secondary education in healthcare or a related field, or equivalent work experience.
- Minimum 2 years in Short Term or Long-Term Disability claims.
- Bilingualism (English and French) required, as you will regularly serve our clients and do business with RBC partners and/or employees across Canada with English and French speaking needs.
- Exceptional verbal and written English skills, with the ability to navigate emotionally sensitive conversations empathetically and professionally.
- Excellent problem-solving and decision-making skills with demonstrated ability to manage complex information and make evidence-based decisions.
- Strong analytical skills to manage complex information and make evidence-based decisions.
- Ability to work independently with strong organizational and time management skills to strategically deliver the greatest impact.
- Ability to meet the technological and confidentiality requirements of the role (internet connectivity, and private space)
- Proficiency in digital tools, Microsoft Outlook, Excel, Word, and ability to navigate multiple systems.
- Basic math skills and an understanding of financial information.
- Nice-to-have Learning Agility: Adaptability and resilience in managing change and evolving processes.
Benefits
- A Total Rewards program that includes flexible benefits, work/life balance and career development programs and investment and retirement savings plans.
- Competitive pay and high-earning potential.
- All the tools, training, and team support you need to grow your career.
- Flexible work/life balance options.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
No Education Requirement
Location requirements
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