Claims Examiner II
ClaimsExaminerII
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Claims Examiner II at Claims Examiner II. Skills: Disability claims, Claims processing. Obtain and analyze data for claims processing. Process New York State statutory Short-Term Disability claims”
What You'll Achieve.
Consistently pay accurate amount for each claim; Meet and exceed production; Meet and exceed attendance; Meet and exceed quality; Meet and exceed service
Industry & Context.
Information analysis; Decision-making
Ability to Travel: None, Sitting for prolonged periods, Frequently standing, Walking distances up to one mile, Bending, crouching, kneeling, Reaching, Occasionally lifting 25lbs, Extensive typing, Picking up and holding small objects, Using primarily fingers, Visual acuity, Hearing sufficient to understand verbal instruction, Hearing sufficient to answer telephones
What They're Looking For.
Must Have
1-3 years NYS statutory Disability and Paid Family leave claims processing experience, High school diploma or equivalent, Experience with Microsoft Office, Work experience in decision-making and information analysis, Demonstrated prioritization and organization skills, Ability to communicate clearly and succinctly verbally and in writing, Ability to organize work, manage time and follow through, Availability to work overtime when required
Nice to Have
Meet and exceed production, attendance, quality and service
What You'll Do.
Obtain and analyze data for claims processing
Process New York State statutory Short-Term Disability claims
Process Paid Family leave claims
Pay accurate amount for each claim
Develop understanding of disability and paid family leave
Develop understanding of applicable claim definitions
Develop operating knowledge of claims system(s)
Develop basic claims skills
Utilize efficient means to obtain claim information
Investigate all relevant claim issues
Provide payment or denials promptly
Research eligibility and pre-existing formulas
Communicate with claimants
Utilize appropriate intervention for claim characteristics
Manage assigned case load
Process claims within specified time requirements
Provide customer service
and manage claimant and policyholder expectations
Document claim file actions
Document telephone conversations appropriately
Handle confidential information with judgment and discretion
How You'll Work.
Team & Collaboration
Work in a team oriented environment
Communication Scope
Written documentation; Verbal communication; Written communication
Full Job Description
# _**Job Responsibilities and Requirements**_ KEY RESPONSIBILITIES _*other duties as assigned*_ The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and**timely processing of New York State statutory Short-Term Disability and Paid Family leave claims.** The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the current laws/regulations. **Research** * Develop an understanding and working knowledge of disability and paid family leave * Develop an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements. * Develop an operating knowledge of the applicable claims system(s). * Develop basic claims skills and an understanding of claim practices and procedures. * Utilizes most efficient means to obtain claim information. **Analysis and Adjudication** * Fully investigates all relevant claim issues with oversight by Manager when needed. * Provides payment or denials promptly and in full compliance with department procedures and regulations. * Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim. * Pro-actively communicates with claimants, policyholders, and physicians when applicable **Case Management** * Utilizes appropriate intervention for the characteristics of each claim. * Manages assigned case load and processes within the specified time requirements. * Good written documentation that provides clear, concise and accurate information to claimants as well as within the claims administrative system. **Customer Service** * Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands. * Establishes, communicates, and manages claimant and policyholder expectations. * Documents claim file actions and telephone conversations appropriately. * Ability to handle confidential information with the utmost judgment and
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