Claims and Benefits Processor II-Remote

ELYON International; Portland (OR); On-site; USD 40,000 - 55,000; Full time

Benefits offered by this job

Paid sick leave

Medical/Dental (optional)

401(k) Retirement Plan (optional)

Employer Paid Life Insurance

Employer Paid Short Term Disability

Optional Life Insurance

Job summary

A leading benefits administration firm in Portland, Oregon is seeking a Benefits Processor to analyze disability claims and make benefit decisions. Responsibilities include investigating claims, ensuring accurate documentation, and providing responsive customer service. Candidates should have a high school diploma and 2-4 years of relevant experience. Key benefits include paid sick leave, medical/dental options, and a 401(k) retirement plan.

Qualifications

• 2-4 years of related work experience or equivalent combination of education and experience.
• Ability to follow up to secure missing information.
• Understanding of Federal, State and local laws affecting claims.

Responsibilities

• Investigate and analyze information for disability benefits.
• Make decisions and issue benefits for claims.
• Provide information and assistance to claimants.

Skills

Attention to detail

Customer service

Document review

Analysis of claim facts

Computer applications

Education

High School diploma or equivalent

Tools

Office equipment

Job description

Summary

The main function of the Benefits Processor 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, policy owners, 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, policy owners, group offices, and other interested parties.
• Provide information and assistance to claimants, policy owners, 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 and Experience

• Education: High School diploma or equivalent.
• Experience: related work experience, or the equivalent combination of education and/or relevant experience.
• 2‑4 Years' Experience.

Benefits

• Paid sick leave
• Medical/Dental (optional)
• 401(k) Retirement Plan (optional)
• Employer Paid Life Insurance
• Employer Paid Short Term Disability
• Optional Life Insurance

ELYON International, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.