Paid Leave Claims Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee new, ongoing, and periodic claims for State-Mandated Disability and Paid Family Leave while adhering to regulatory and departmental timelines.

• Examine claimant, employer, medical, and other pertinent documentation to assess benefit eligibility, claim length, and payable benefits.

• Make prompt and precise decisions to approve, pend, or deny assigned claims in accordance with applicable regulations, policy guidelines, and departmental protocols.

• Engage with claimants, policyholders, employers, and healthcare providers through both phone and written communications.

• Prioritize incoming correspondence and assigned tasks to fulfill service-level agreements and mandated turnaround times.

• Accurately compute and process relevant benefits and taxes.

• Ensure clear, complete, and precise documentation for all claims.

• Recognize and escalate complex or atypical claim scenarios.

• Achieve established productivity, financial, and quality benchmarks.

• Review and address quality audits and associated correspondence.

• Deliver prompt, accurate, and courteous service to both internal and external clients.

• Collaborate with various teams to resolve claim-related issues and support departmental and organizational goals.

• Engage in projects, process enhancements, and other departmental tasks as required.

⛳️ Requirements

• High School diploma is mandatory.

• 1–2 years of experience in a disability or leave claims setting is essential.

• Excellent customer service and communication capabilities.

• Strong attention to detail and superior organizational skills.

• Technological proficiency and adaptability.

• Collaborative mindset and problem-solving skills.

• Knowledge of federal and state regulations regarding leaves of absence.

• Ability to assess and process disability and leave claims effectively.

• Proficiency in Microsoft Excel and Word is required.

• Experience in administering State-Mandated Disability claims is preferred.

• Familiarity with short-term disability, long-term disability, and/or FMLA claims is preferred.

• Background in a productivity- and quality-focused claims environment is preferred.

• A college degree or at least three (3) years of equivalent work experience is preferred.

• A Bachelor’s degree or a combination of education and relevant work experience is highly regarded.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance.

• Mental health benefits.

• Employee assistance program.

• Paid time off.

• Paid parental leave.

• Short-term disability coverage.

• Cultural observance day.

• Contributions to healthcare accounts.

• Pension plan.

• 401(k) plan with company matching.

• ProHealth Rewards wellness platform offering cash incentives.