Claims Specialist

HR Solutions; Lancaster (Lancaster County); On-site; USD 65,000 - 90,000; Full time

Job summary

HR Solutions is hiring a Disability Claims Specialist to support our Leave Administration efforts. The role requires hands-on experience managing short-term disability claims, reviewing medical documentation, and determining functional limitations.

The candidate should have prior disability claims adjudication, request for additional information, and collaboration with managers on return-to-work or modified duty.

Qualifications

• Experience in short-term disability case management, reviewing medical notes, and approving/denying claims.
• Ability to request additional medical information and coordinate return-to-work or modified duty.
• Familiarity with ADA interactive processes and accommodation reviews.

Responsibilities

• Interpret medical notes and determine functional limitations.
• Identify insufficient documentation and seek clarifications from providers or employees.
• Communicate decisions clearly to employees and managers, including justification.
• Support the ADA process and accommodation determinations as needed.
• Use strong judgment to push back when documentation does not support a request.

Skills

Disability claims

Medical documentation review

ADA exposure

Strong judgment

Communication with providers

Job description

We are hiring a Disability Claims Specialist to support our Leave Administration Manager. We need someone with hands‑on experience managing short‑term disability (STD) claims, reviewing medical documentation, and determining functional limitations. This person must have previously adjudicated disability claims, requested additional medical information, and partnered with managers on return‑to‑work or modified duty.

Ideal candidates have experience in disability case management and exposure to ADA accommodation processes. They should be comfortable interpreting medical documentation, identifying insufficient information, and making defensible decisions.

1. Real disability claims experience

Candidates should have experience in short‑term disability case management, reviewing medical documentation, determining functional limitations, approving or denying claims, requesting additional medical information, and coordinating return‑to‑work or modified duty.

2. Medical documentation review

They must be able to read and interpret medical notes, identify insufficient documentation, understand restrictions versus limitations, spot inconsistencies, and communicate with providers or employees to clarify documentation.

3. ADA exposure

We want candidates who have participated in the ADA interactive process, reviewed medical documentation for accommodation requests, understood functional limitations and job requirements, and helped determine whether a request may qualify under ADA. They do not need to be ADA experts, just familiar enough to support the process.

4. Strong judgment and ability to push back

Recruiters should screen for candidates who can say documentation does not support a request, are comfortable requesting additional medical information, can explain decisions clearly to employees and managers, and have handled sensitive or complex cases.