715-1 - Claims & Benefits Processor II (Insurance - Remote)

Claims & Benefits Processor II

Summary:

The main function of the Claims & Benefits Processor II is to analyze disability claim information, make benefit decisions and payments on lower liability claims; administer low maintenance claims; provide administrative support for the department's management of disability claims including the set-up and distribution of new claims; provide responsive customer service to claimants, policyowners, benefits staff, and group offices.

Job Responsibilities:

Investigate, secure and analyze information pertaining to claimant's medical condition, insured status and other policy provisions to accurately determine eligibility for, and entitlement to disability benefits for low liability and short duration claims; identify, file/fact discrepancies and outstanding issues and secure additional documentation as needed while investigating within prescribed time frames

Make and communicate disability decisions and issue correct benefits for low liability and short duration claims

Establish system records, analyze member eligibility, set up new claim files, provide updates to claimants on incomplete claims and respond to inquiries from claimants, policyowners, group offices, and other interested parties

Provide information and assistance to claimants, policyowners, and group offices by promptly answering telephones and responding to specific questions about claims and policies

Maintain reserves on assigned low liability and short duration claims

Provide administrative support for the team's management of disability claims

Gather information and take each file from pre-approval to closing

Verify benefit claim documents

Collect required documentation, review file documentation, and make sure all items needed are requested

Ensure that all claim documentation is complete, accurate, and complies with company policy

Establish, maintain, and update files, databases, records, and other documents for recurring internal reports

Skills/Qualifications:

Attention to detail and accuracy; express ideas clearly in written and verbal form; prioritize tasks to meet multiple and changing deadlines; accurately keyboard 35 WPM; customer service

Ability to review documents for completeness and follow up to secure missing information; analyze claim facts and apply contract provisions accurately

Ability to understand and apply Federal, State and local laws and regulations affecting claim investigation, disability decisions and taxation of benefits, such as Fair Claim Settlement Practices Act, ERISA, and Federal, State and local tax withholding and reporting requirements as they apply to low liability

Ability to adjust schedule to accommodate peak work periods or department workload; use department's automated claim system and other computer applications

Working knowledge of Office equipment including a word processor or personal computer

Education/Experience:

Education:

High School diploma or equivalent

Associates Degree highly preferred

Experience:

Related work experience, or the equivalent combination of education and/or relevant experience

2-4 Years' Professional Work Experience