Claims Management Specialist

Maine Public Employees Retirement System (MainePERS); Augusta (ME); Hybrid; USD 61,000 - 75,000; Full time

Benefits offered by this job

13 Paid Holidays

Health Insurance

Dental Insurance

Vision Care

Life Insurance

Defined Benefit Pension Plan

Deferred Compensation Plan

Tuition Reimbursement

Parental leave

Vacation and Sick Leave

Job summary

Maine Public Employees Retirement System (MainePERS) seeks a detail-oriented Claims Management Specialist to oversee disability retirement and rehabilitation programs in Augusta, ME. You will evaluate applications, review ongoing eligibility, and coordinate rehabilitation services.

You will gather medical and vocational information, determine eligibility with the Medical Review Service Provider, and communicate with members, employers, providers, and stakeholders.

Qualifications

• Bachelor’s degree or equivalent administrative experience in a related field.
• Experience applying complex laws, regulations, or procedures a plus.
• Proficiency with Microsoft Office applications.

Responsibilities

• Evaluate disability retirement applications and continuing eligibility for benefits.
• Gather, review, and analyze medical, vocational, and employment information.
• Assess ability to perform essential job functions and evaluate accommodations.
• Issue eligibility determinations with Medical Review Service Provider.
• Coordinate rehabilitation services and monitor program compliance.
• Communicate effectively with members, employers, healthcare providers, and stakeholders.
• Assist with appeals and provide guidance on disability and rehabilitation matters.
• Represent the organization at meetings, presentations, and public outreach events.

Skills

Analytical skills

Problem-solving

Communication

Judgment

Customer service

Collaboration

Education

Bachelor's degree in related field

Associate's degree in related field

Equivalent combination of education and experience

Tools

Microsoft Office

Job description

Maine Public Employees Retirement System (MainePERS) is seeking a detail-oriented and analytical Claims Management Specialist to oversee disability retirement and rehabilitation programs. In this role, you will evaluate disability retirement applications, review ongoing eligibility for benefits, and coordinate rehabilitation services. You will work closely with members, employers, healthcare providers, and medical review professionals to ensure fair, timely, and accurate determinations.

What You'll Do

• Evaluate disability retirement applications and continuing eligibility for benefits.
• Gather, review, and analyze medical, vocational, and employment information.
• Assess individuals' ability to perform essential job functions and evaluate reasonable accommodations.
• Issue eligibility determinations in consultation with the Medical Review Service Provider.
• Coordinate rehabilitation services and monitor program compliance.
• Communicate effectively with members, employers, healthcare providers, and other stakeholders.
• Assist with appeals and provide technical guidance on disability and rehabilitation matters.
• Represent the organization at meetings, presentations, and public outreach events.

What We're Looking For

• Strong analytical and problem-solving skills.
• Excellent written and verbal communication abilities.
• Sound judgment and the ability to make timely decisions.
• A commitment to accuracy, accountability, and exceptional customer service.
• The ability to build trust and work collaboratively with diverse audiences.

Minimum Qualifications

• Bachelor's degree in a related field and two years of progressively responsible administrative experience; OR
• Associate's degree in a related field and five years of complex administrative or technical experience; OR
• An equivalent combination of education and experience.
• At least one year of experience applying complex laws, regulations, policies, or procedures.
• Proficiency with Microsoft Office applications.

Preferred Qualifications

• Experience evaluating medical evidence and determining eligibility for benefits or services.
• Experience in disability determination, vocational rehabilitation, insurance claims, or a related field.

Salary

Begins at $67,787 (if annualized).

Benefits

• 13 Paid Holidays
• Health Insurance
• Dental Insurance (fully paid)
• Vision Care
• Life Insurance
• Defined Benefit Pension Plan
• Deferred Compensation Plan
• substantial Tuition Reimbursement
• Parental leave
• Generous Vacation and Sick Leave

Eligible for a hybrid work schedule after a successful probationary period.