Claims Specialist

Job Summary

Providing comprehensive absence case management, the full-time Claims Specialist will adjudicate claims based on medical documentation, determine benefits due, and manage communications with claimants and clients in a remote setting.

Key responsibilities

• Analyze and adjudicate claims for Disability, FMLA, and Paid Family Leave based on medical documentation
• Review and secure missing documentation for claims, ensuring compliance with guidelines and regulations
• Communicate effectively with claimants and clients to set expectations and manage the claims process

Required qualifications

• 1+ year of experience in Disability/FMLA/PFL claims or insurance claims
• Experience with FINEOS software
• Working knowledge of medical terminology and documentation
• Understanding of disability insurance claims and benefits administration
• Proficiency in MS Office applications, including Excel and Word