Claim And Benefits Processor

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, policyowners, 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, policyowners, group offices, and other interested parties.

• Provide information and assistance to claimants, policyowners, 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/Experience:

• Education: High School diploma or equivalent.

• Experience: related work experience, or the equivalent combination of education and/or relevant experience

• 0-2 Years' Experience

Must be able to work core PST business hours. Training hours will likely be in PST (8am-5pm).