Senior Leave & Life Event Claims Specialist

Unum; Oregon; Hybrid; USD 53,000 - 101,000; Full time

Benefits offered by this job

Healthcare benefits

Paid time off including volunteer time

401(k) employer match

Tuition reimbursement

Student loan repayment options

Job summary

Unum is seeking an advanced level technical position responsible for the thorough, fair, objective, and timely adjudication of the most complex short-term disability claims in conjunction with providing technical expertise regarding FMLA and state leave regulations. This role focuses on delivering excellent customer service while collaborating with employees, employers, and health care providers.

The position requires healthcare/medical background or leave management experience, strong

Qualifications

• 4-year degree preferred or equivalent work experience
• 3+ years in the Leave or Disability Benefit Specialist role
• Mastery of key responsibilities and job specifications of Leave or Disability Benefit Specialist roles
• Medical background, disability claim and/or leave management experience preferred
• Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions
• Strong analytical and problem-solving skills

Responsibilities

• Timely and accurate adjudication of complex STD claims
• Processing of leaves associated with an employee’s own health condition
• Apply technical contractual knowledge to ensure appropriate eligibility and liability decisions
• Determine complex eligibility and availability of leave for integrated claims/leaves
• Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities
• Determine and generate appropriate communications to comply with FMLA and state regulations
• Facilitate roundtables when consulted or manager is unavailable
• Provide technical coaching and mentor support to less experienced Benefit Center professionals
• Provide Manager/Director with performance and development feedback for assigned mentees
• Is viewed as a role model, technical expert and leader within the team and Benefits Center
• Provide coverage of daily tasks including customer inquiries and attending customer calls as needed and in times of management absence
• Verify ongoing liability and return to work opportunities as appropriate
• Provide excellent customer service by paying appropriate claims promptly and quickly
• Develop relationships with Employer contacts, including HR administrators
• Coordinate file strategies utilizing nurses, physicians, vocational rehabilitation and assessing medical documentation
• Ensure timely referrals to other areas as appropriate
• Ensure a timely and well communicated transfer process when transitioning integrated claims from STD to LTD
• Maintain organizational service standards on all assigned claims and leaves
• Be familiar with specialized workflow requirements and performance standards for any assigned customers
• May perform other duties as assigned

Skills

Analytical skills

Problem solving

Customer service

Independent judgment

Communication skills

Education

Bachelor’s degree preferred or equivalent experience

Job description

Unum is seeking an advanced level technical position responsible for the thorough, fair, objective, and timely adjudication of the most complex short-term disability claims in conjunction with providing technical expertise regarding FMLA and state leave regulations. This role focuses on delivering excellent customer service while collaborating with employees, employers, and health care providers.

The position requires healthcare/medical background or leave management experience, strong