Specialist

Operational Responsibilities

·       Review and administer claims while adhering to regulatory and company plan requirements

·       Update systems to accurately reflect claim status and ensure appropriate claim documentation

·       Maintain clear and accurate written and verbal communication with employee, employer, physician’s office, and/or other relevant parties via letters, calls, email, fax, or other systems

·       Interact with claims specialists, claims support specialists, unit leaders, and QA partners

Quality, Compliance & Productivity

·       Meet daily/weekly/monthly performance targets as defined by SLA and internal metrics

·       Ensure that all transactions meet quality standards set by Quality Assurance

·       Maintain compliance with regulatory requirements (e.g., FMLA guidelines, state disability rules, HIPAA principles where applicable)

·       Ensure adherence to established attendance schedules

Other Functional Requirements

·       Work as a team member to meet enterprise goals to obtain disability’s vision while demonstrating core values and meeting key measures

·       Adapt to process updates, system changes, and evolving client requirements

·       Utilize MS Office and other productivity tools to improve efficiency

·       Perform additional tasks or responsibilities assigned by the supervisor as needed