Insurance Claims Processing Jobs in Portland, ME

Job Classification:

This Senior Level Claim Manager role will provide concierge-level customer service to one of Group Insurance's largest clients. By gaining a deep understanding of the client's culture and using expert customer service skills, the Senior Claim Manager will take a consultative approach in guiding and coaching our client's employees through the life cycle of a disability claim. With exposure to multiple products, including Short Term Disability, Statutory Leaves, Absence, Long Term Disability, and Life Waiver of Premium, the Senior Claim Manager will deliver world-class service that ensures a more effortless experience for the employee.

As an exceptional collaborator, the Senior Claim Manager will engage Expert Resources to further enhance the claim journey, addressing Behavioral Health and Vocational opportunities within their block of claims. This Concierge Team Member will have the opportunity to interact directly with the Leave team at the client during quarterly virtual meetings and will interface daily with the client's Benefits Business Partners.

As an innovator, the Senior Claim Manager will seek out opportunities to further enhance the claimant experience and will serve as an ambassador for continuous process improvement within the Concierge Team.

The Senior Level Claims Manager is responsible for providing excellent customer service while managing an assigned block of around 75 Long-Term Disability (LTD) and Short-Term Disability (STD) claims. The assigned claim block will fluctuate between more or fewer LTD and STD claims, depending on the team's needs. The Senior Claims Manager will be responsible for overseeing a block of complex claims, including those with co-morbidities, behavioral health issues, and self-reported symptoms.

Qualifications:

• 3+ years of LTD experience is required

• STD claim handling and Life Waiver of Premium experience and/or understanding is preferred

• Expert-level, proactive communication skills using a variety of pathways including telephone, email, letters, Teams messaging, group Teams calls, and one-on-one video calls to deliver exceptional, white-glove service to the customer

• An energetic customer focus evidenced through maintaining customer relationships

• Confidence in communicating with highly skilled and highly educated claimants in the software industry

• Ability to interact confidently with attorneys and specialty medical professionals such as Psychiatric providers

• Excellent documentation skills to capture the essence of telephone conversations and to establish clear, concise claim plans

• Ability to comprehend and interpret complex and non-standard policy and plan provisions

• Strong ability to independently work through ambiguous situations and adjust course quickly when needed

• Advanced math skills with the ability to perform financial calculations related to salary and incentives, partial disability calculations, RTW incentives, and offsets

• Provides technical direction to other claims personnel as needed

• Excellent organizational and time management skills

• Demonstrated teamwork skills and ability to leverage resources to attain goals

This position will work virtually; therefore, new hires must be able to provide the following & all new hires who work remotely will be held accountable to these standards:

• Subscribe to an internet service provider plan with at least 25 Mbps download speeds. You must be willing to troubleshoot any issues or outages with your home internet service, contacting your service provider as necessary.

• Must have the capability to handle calls with a cell phone (would need to have unlimited data and minutes) or a landline. Your personal phone number will not be identified to customers.

• Quiet area in your home with minimal distractions and noise-free.

• Reliability and dependability throughout our extensive training program are required.

#LI-IN

• Market competitive base salaries, with a yearly bonus potential at every level.

• Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.

• 401(k) plan with company match (up to 4%).

• Company-funded pension plan.

• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.

• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.

• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.

• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.

Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week.