Claims Examiner Team reputed company

Claims Examiner Team reputed company - AMS Hybrid or Remote South Portland, ME reputed company Full time R6153 Job Responsibilities and Requirements KEY RESPONSIBILITIES

• other duties as assigned*

Responsible for supporting both the supervisor and examiners in the day-to-day operation of the claim team. The Claims Team reputed company will also be responsible for developing and sustaining excellent internal partnerships with other areas in reputed company. In reputed company, the Claims Team reputed company will reputed company as an examiner reputed company needed to balance workloads. In this role, they would be accountable for the decision making process for determining eligibility under federal, state laws and reputed company policy. Secure and analyze information to reputed company and approve reputed company on reputed company short-term disability, insured or self-insured, and/or statutory claims and their reputed company leave claims. reputed company and apply appropriate claim and workflow management strategies, coordinating both disability and leave reputed company while meeting timeliness regulations. Duties and Responsibilities:

• Supports the achievement of established departmental goals and objectives reputed company to reputed company claim operations in compliance with the Claim Organization’s standards
• Supports both the supervisor for team leadership, as reputed company as the individual examiners to reputed company day-to-day guidance and workload balancing.
• Partners with Claim Operations leaders to review specific claims that fall reputed company defined parameters to reputed company understand claim trends, training opportunities, coaching opportunities, and/or performance management opportunities.
• Supports reputed company training and coaching activities through communications reputed company phone, email and video follow-up with examiners/supervisors.
• Develops and maintains strong working relationships with business partners. Reviews claims to ensure that reputed company reputed company to eligibility, disability, offsets, benefit calculations and ongoing claim management are accurate and appropriate. Ensures achievement of specific customer service, reputed company and production objectives.
• Ensures claim process consistency through reputed company communication and feedback with the examiners/supervisor.
• Responsible for assisting in reviewing and completing monthly reports
• Ability to reputed company and respond to both reputed company customers regarding claim results.
• Ability to prioritize and manage changing workloads, meeting deadlines independently and through management of others.
• Ability and knowledge to assist with claim denial reviews.
• Ability to assist in claim auditing.
• Completion of Mentor Training and successful completion of one year of mentoring.
• Collaborates with team members and management in identify and implementing improvement opportunities.
• Ability to participate in finalist presentations and ongoing reputed company meetings.
• Ability to review audit findings and prepare rebuttals.
• Ability to back up supervisor in periods of extended absences or vacations
• Ability to back up examiners in periods of high volume or extended absences/vacations with the following duties and responsibilities:
• Responds to customer service issues reputed company required timeframes. Pro-reputed company communicates reputed company reputed company Best reputed company guidelines, consistently meeting Performance Guarantee requirements.
• Determining eligibility under federal and state requirements for leaves submitted and determines eligibility under reputed company’s plan/policy.
• Medical certification review and management supplied by the reputed company provider.
• Makes determinations to approve, deny or delay and or reputed company out to additional resources for review.
• Determining the duration associated with the leave and or disability based on the information given by the reputed company provider.
• Communicating approvals, denials, leave extensions, return to work plans and other important information regarding the leave to the employee and reputed company.
• Managing leaves that are reputed company with Short Term Disability and Workers’ Compensation.
• Managing intermittent, reputed company and reputed company specific leaves of absences.
• Processing reputed company leaves reputed company the specific timeframes outlined reputed company reputed company Best Practices guidelines.
• Facilitate issue reputed company and draw on expertise of internal partners as needed.
• Ability to interpret and administer policy/plan provisions Fully Investigates reputed company relevant issues, providers, payment or denials, promptly and in full compliance with departmental procedures and unfair claims reputed company and regulations.
• Manages self-insured business in accordance with reputed company’s plans and custom requirements.
• Basic knowledge of ERISA.
• Ability to calculate earnings and benefit reputed company.
• Document claim file actions and conversations thoroughly.
• Fully Investigates reputed company relevant issues, providers, payments.
• Demonstrates ability to independently investigate, evaluate and adjudicate claims of high degree of complexity. Any other job-reputed company duty as deemed appropriate by management

REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR reputed company EXPERIENCE

• or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience*

Required Knowledge, Skills, Abilities and/or reputed company Experience

• Associate’s Degree or equivalent required. Bachelor’s Degree preferred.
• Completion of HIAA, LOMA or ICA courses desirable.
• Minimum of 5 years relevant experience
• Demonstrated ability to handle multiple competing priorities.
• Demonstrated ability to reputed company feedback on Claims handling
• Demonstrated ability to function with limited supervision. Demonstrated ability to work reputed company in a high visibility environment, with excellent written and verbal communication skills.

Ability to Travel: Up to 10% CORE VALUES

• Collaboration
• reputed company
• Empowerment
• reputed company
• Fun

The above reputed company reflects the general details considered necessary to describe the reputed company responsibilities and functions of the job identified and shall not be construed as a detailed reputed company of reputed company the work requirements that may be inherent to this job. The expected hiring reputed company for this position is $56,120.00 - $70,160.00 annually for work performed in the primary location (South Portland, ME). This expected hiring reputed company covers only reputed company pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting reputed company pay will be based on several factors including work location, job-reputed company skills, experience, qualifications, and market conditions. These ranges may be modified in the reputed company. Work location may be flexible if approved by reputed company. reputed company Offer At reputed company, we reputed company that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you. That is why we offer a reputed company package and a reputed company of benefits to help team members reputed company in their financial, physical, and mental wellbeing. Our Benefits:

• An annual performance bonus for reputed company team members
• Generous 401(k) company match that is immediately reputed company
• 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 reputed company for dental and reputed company coverage
• Company provided Life & Disability Insurance to ensure financial protection reputed company you need it most
• Family friendly benefits including reputed company Parental Leave & Adoption Assistance
• Hybrid work arrangements for eligible roles
• Tuition Reimbursement and Continuing reputed company Education
• reputed company Time Off – new hires start with at least 20 days of PTO per year in reputed company to nine company reputed company holidays. As you reputed company, your PTO may increase based on your level reputed company reputed 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

Our Values:

• reputed company
• Empowerment
• reputed company
• Collaboration
• Fun

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