Paid Leave Claims Specialist

OpenKrill; USA; Remote; USD 50.000 - 70.000; Vollzeit

Benefits dieser Stelle

Health insurance

Paid time off

401(k) with company matching

Pension plan

Zusammenfassung

Protective is seeking a Paid Leave Claims Specialist to guide claimants through life events with accurate, empathetic service. You will evaluate disabilities and leave claims, review documentation, and determine eligibility and benefits within regulatory requirements.

This role requires attention to detail, collaboration across teams, and the ability to balance productivity with quality in a fast-paced environment.

Qualifikationen

• Strong customer service and communication abilities.
• Attention to detail and organizational skills.
• Knowledge of federal and state leaves of absence laws.
• Ability to evaluate and process disability and leave claims.
• Proficiency in Microsoft Excel and Word.

Aufgaben

• Manage new, ongoing, and periodic State-Mandated Disability and Paid Family Leave claims within required regulatory and departmental timeframes.
• Review claimant, employer, medical, and other relevant documentation to determine benefit eligibility, claim duration, and benefits payable.
• Make timely and accurate decisions to approve, pend, or deny assigned claims in accordance with applicable regulations, policy provisions, and departmental procedures.
• Communicate with claimants, policyholders, employers, and healthcare providers by phone and in writing to obtain information necessary for initial and ongoing claim management.
• Prioritize incoming correspondence and assigned work to meet service-level and mandated turnaround requirements.
• Accurately calculate and process applicable benefits and taxes.
• Maintain clear, complete, and accurate claim documentation, including decisions, actions, and customer interactions.
• Identify and escalation complex or unusual claim situations to the appropriate subject matter expert or Claims Supervisor.
• Meet established productivity, financial, and quality standards while maintaining accurate claim decisions and a positive customer experience.
• Review and respond to quality audits and related correspondence.
• Provide prompt, accurate, and courteous service to internal and external customers.
• Collaborate across teams to resolve claim issues and support departmental and organizational objectives.
• Participate in projects, process improvements, and other departmental assignments as needed.

Kenntnisse

Customer service

Attention to detail

Regulatory knowledge

Microsoft Excel & Word

Communication skills

Teamwork

Problem-solving

Technology aptitude

Ausbildung

Bachelor’s degree or equivalent experience

High School diploma

Tools

Microsoft Excel

Microsoft Word

Jobbeschreibung

The work we do has an impact on millions of lives, and you can be a part of it.We help protect our customers against life’s uncertainties. Regardless of where you work within the company, you’ll be helping provide protection and peace of mind when our customers need it most.

As a Paid Leave Claims Specialist, you will help claimants navigate important moments in their lives by delivering timely, accurate, and empathetic claim service. You will manage Paid Leave claims from initial review through ongoing administration, evaluating claimant, employer, and medical information to determine eligibility, claim duration, and benefits payable.

This role is well suited for an experienced disability or leave professional who combines sound judgment with strong customer service. You will work in a collaborative, technology-enabled environment where accuracy, regulatory compliance, and responsiveness are essential.

The intended start date for this hiring class is 11/30/2026.

Key Responsibilities

• Manage new, ongoing, and periodic State-Mandated Disability and Paid Family Leave claims within required regulatory and departmental timeframes.
• Review claimant, employer, medical, and other relevant documentation to determine benefit eligibility, claim duration, and benefits payable.
• Make timely and accurate decisions to approve, pend, or deny assigned claims in accordance with applicable regulations, policy provisions, and departmental procedures.
• Communicate with claimants, policyholders, employers, and healthcare providers by phone and in writing to obtain information necessary for initial and ongoing claim management.
• Prioritize incoming correspondence and assigned work to meet service-level and mandated turnaround requirements.
• Accurately calculate and process applicable benefits and taxes.
• Maintain clear, complete, and accurate claim documentation, including decisions, actions, and customer interactions.
• Identify and escalation complex or unusual claim situations to the appropriate subject matter expert or Claims Supervisor.
• Meet established productivity, financial, and quality standards while maintaining accurate claim decisions and a positive customer experience.
• Review and respond to quality audits and related correspondence.
• Provide prompt, accurate, and courteous service to internal and external customers.
• Collaborate across teams to resolve claim issues and support departmental and organizational objectives.
• Participate in projects, process improvements, and other departmental assignments as needed.

Skills, Knowledge, and Abilities:

• Strong customer service and communication skills
• Attention to detail and organizational skills
• Technological aptitude and adaptability
• Teamwork and problem-solving abilities
• Knowledge of federal and state laws on leaves of absence
• Ability to evaluate and process disability and leave claims
• Proficiency in Microsoft Excel and Word

Minimum Requirements

• High School diploma required
• College degree or an equivalent of at least three (3) years of work experience preferred
• 1-2 years’ experience in a disability or leave claims environment required

Preferred Qualifications

• 2+ years of disability claims or leave administration experience
• Experience administering State-Mandated Disability claims
• Experience with short-term disability, long-term disability, and/or FMLA claims
• Bachelor’s degree or an equivalent combination of education and relevant work experience
• Experience working in a productivity- and quality-measured claims environment

Schedule Details

• This role operates on a semi-flex 40 hour a week, M-F schedule. All schedules will be approved based on business needs.

The internal title for this role is Specialist II Claims. #ind123 #LI-AP1

Employee Benefits:We aim to protect the wellbeing of our employees and their families with a broad benefits offering. In addition to offering comprehensive health, dental and vision insurance, we support emotional wellbeing through mental health benefits and an employee assistance program. Work/life balance is important and Protective offers a variety of paid time away benefits (e.g., paid time off, paid parental leave, short-term disability, and a cultural observance day). The financial health of our employees is just as important as physical and emotional health. Some of the financial wellbeing benefits include contributions to healthcare accounts, a pension plan, and a 401(k) plan with Company matching. All employees are encouraged to protect their overall wellbeing by engaging in ProHealth Rewards, Protective’s platform to improve wellbeing while earning cash rewards.

Eligibility for certain benefits may vary by position in accordance with the terms of the Company’s benefit plans.

Accommodations for Applicants with a Disability:

If you require an accommodation to complete the application and recruitment process due to a disability, please email [e-mail]. This information will be held in confidence and used only to determine an appropriate accommodation for the application and recruitment process.

Please note that the above email is solely for individuals with disabilities requesting an accommodation. General employment questions should not be sent through this process.

We are proud to be an equal opportunity employer committed to being inclusive and attracting, retaining, and growing an inclusive workforce.