Claims Specialist managing high exposure casualty and specialty claims for Hamilton Select. Responsible for mentoring new adjusters and ensuring compliance with corporate guidelines.
About the role
- 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.
Responsibilities
- 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.
Requirements
- 2 years STD claims examiner experience (Short Term Disability)
- Associates Degree, Bachelors Preferred
- Promptly acknowledges customers' needs, both internal and external.
- Ensures customers' needs are handled in a timely and appropriate manner.
- Creates a positive impression.
- Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback.
- Communicate/respond appropriately to varied audiences/tasks.
- Exhibits teamwork, honors commitments.
- Anticipates, analyzes and defines problems.
- Develops and assesses alternative solutions as necessary.
- Makes appropriate decisions in a timely manner.
- Analyzes impact of decisions.
- Work is accomplished quickly and accurately.
- Takes responsibility for actions.
- Prioritizes work effectively and uses time efficiently.
- Accomplishes goals and objectives.
- Makes/fulfills commitments.
- Consistently works independently, meets deadlines, and accepts responsibility for his/her actions.
- Adheres to all attendance requirements.
- Prompt, well prepared and ready to contribute.
- Level I LOMA Designation Preferred
- Ability to Travel: None
Benefits
- An annual performance bonus for all team members
- Generous 401(k) company match that is immediately vested
- A choice of three medical plans (that include prescription drug coverage) to suit your unique needs.
- For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account
- Multiple options for dental and vision coverage
- Company provided Life & Disability Insurance to ensure financial protection when you need it most
- Family friendly benefits including Paid Parental Leave & Adoption Assistance
- Hybrid work arrangements for eligible roles
- Tuition Reimbursement and Continuing Professional Education
- Paid Time Off – new hires start with at least 20 days of PTO per year in addition to nine company paid holidays.
- As you grow with us, your PTO may increase based on your level within the company and years of service.
- Volunteer days, community partnerships, and Employee Assistance Program
- Ability to connect with colleagues around the country through our Employee Resource Group program
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