Claims Administrator I ( STD Case Specialist )

Aquent; Wellesley (MA); On-site; USD 55,000 - 75,000; Full time

Job summary

Aquent partners with a leading financial services organization to deliver expert disability claims adjudication and superior client service. The Case Specialist role emphasizes timely, accurate determinations and autonomy within a collaborative team.

You will review claims, authorize payments within guidelines, and interpret legal/medical terminology to support fair, compliant decisions while communicating clearly with all parties involved.

Qualifications

• Strong mathematical aptitude for precise calculations and claim payments.
• Excellent judgment and decision‑making to adjudicate claims per policy provisions.
• Ability to interpret legal and medical terminology for claim decisions.
• Exceptional organizational skills to manage multiple tasks.
• Ability to communicate effectively with internal/external contacts while handling confidential information.
• Strong client service focus and problem‑solving orientation.

Responsibilities

• Deliver services to clients and claimants, independently and with a team.
• Review claims and make final determinations on benefit approvals or denials.
• Authorize claim payments within established limits.
• Evaluate duration guidelines using clinical/vocational resources for correct dispositions.
• Document strategic assessments to ensure efficient adjudication.
• Interpret contracts to ensure fair claims practices and compliance with laws.
• Gather supporting documentation and communicate with employers, claimants, physicians, attorneys, and others.
• Support claims staff or assist with special projects as needed.

Skills

Mathematical aptitude

Judgment & decision‑making

Legal & medical terminology

Organizational skills

Confidential information handling

Client service focus

Analytical problem solving

Effective communication

Deadline oriented

Autonomous yet collaborative

Education

Associate or Bachelor degree

Job description

Aquent is partnering with a leading financial services organization dedicated to making a tangible difference in the lives of individuals, families, and communities worldwide. This organization prides itself on fostering a dynamic environment where unique backgrounds and perspectives are celebrated, and every team member is empowered to reach their full potential. You’ll join a team of experts eager to share knowledge, and leaders committed to inspiring your growth. This is an opportunity to contribute to a mission that brightens lives, delivering superior service and support to clients at every turn.

About the Role

Step into a pivotal role as a Case Specialist, where your expertise will directly impact the well‑being of clients by ensuring timely and accurate resolution of short‑term disability claims. You will be at the heart of service delivery, making critical decisions that provide peace of mind and essential support during challenging times. This fast‑paced and exciting environment offers the chance to work autonomously while being an integral part of a collaborative team, contributing significantly to client satisfaction and the organization’s commitment to excellence.

What You’ll Do

• Work both independently and collaboratively to deliver exceptional service to clients and claimants.
• Review claims thoroughly and make final determinations regarding benefit approval or denial.
• Authorize claim payments within established limits, leveraging appropriate guidelines.
• Evaluate duration guidelines and recommendations from clinical and vocational resources to determine the correct disposition of claims.
• Document and act on strategic assessments to ensure claims are adjudicated efficiently and accurately.
• Interpret contracts to ensure fair and consistent claims practices, adhering to all relevant laws, regulations, and procedures.
• Gather necessary supporting documentation to substantiate disability claims and communicate effectively with employers, claimants, physicians, attorneys, and other relevant parties.
• Contribute to other related duties, such as supporting claims staff or assisting with special projects, as business needs arise.

What You’ll Bring

• Strong mathematical aptitude for precise calculations and claim payments.
• Excellent judgment and decision‑making skills to adjudicate claims in line with policy provisions.
• Proven ability to comprehend and interpret legal and medical terminology for claim decisions.
• Exceptional organizational skills and the capacity to effectively manage multiple tasks.
• Ability to communicate effectively with internal and external contacts while handling highly confidential information.
• A strong client service focus, always seeking solutions.
• Effective analytical and problem‑solving capabilities.
• Resilience and adaptability to thrive in a fast‑paced and demanding environment.
• A track record of successful autonomous work alongside effective team collaboration.
• Outstanding written and verbal communication skills.
• Strong interpersonal skills.
• Demonstrated ability to meet deadlines with a high degree of accuracy and attention to detail.

Bonus Points

• Associate or Bachelor degree.
• Prior claim management experience.