STD Claims Examiner II

Job Responsibilities and Requirements

Obtains and analyzes information to make claim decisions and payments of Short Term Disability (STD) claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the contract.

• Applies knowledge of disability products, policies and contracts.
• Interprets and applies contract/policy definitions of disability and relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements.
• Utilizes reference materials and tools regarding medical, vocational and disability issues to identify and evaluate claim information in a fair and objective manner.
• Efficient use of applicable disability claims system(s).
• Applies routine medical and technical claims skills, practices, and procedures.
• Utilizes most efficient means to obtain claim information.

• Fully investigates all relevant claim issues.
• Provides payment or denials promptly and in full compliance with department procedures and regulations.
• Involves technical resources (Social Security specialist, medical resources, and vocational resources) at appropriate claim junctures.
• Determine and implement appropriate return to work strategy for assigned cases.
• Applies contract specifics regarding eligibility and pre-existing formulas in reference to specific claim.
• Communicates with claimants, policyholders, and physicians to resolve investigations concerns.
• Comfortably makes balanced decisions in situations where there are potential adverse consequences.

• Utilizes appropriate intervention for the characteristics of each claim.
• Manages assigned case load of 100-110 complex and some simple cases independently.
• Collaborates with team members and management in identifying and implementing improvement opportunities.
• Manages appropriate volumes, consistently meeting turnaround times, high activity levels, and quality focus on timely claim activities.
• Consistently remain within workflow guidelines on diaries and casework & adjust desk management if needed.
• Provides clear, concise and accurate information to claimants as well as the claims administrative system.
• Serves as a subject matter expert within team, provides some mentor support for newer examiners to assist in their development.

• Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
• Establishes, communicates, and manages claimant and policyholder expectations.
• Documents claim file actions and telephone conversations appropriately.

• 2 years STD claims examiner experience (Short Term Disability)
• Associates Degree, Bachelors Preferred
• Promptly acknowledges customers' needs, both internal and external. Ensures customers' needs are handled in a timely and appropriate manner. Creates a positive impression.
• Demonstrates effective interpersonal and listening skills: takes direction, practices active listening, accepts feedback. Communicate/respond appropriately to varied audiences/tasks. Exhibits teamwork, honors commitments.
• Anticipates, analyzes and defines problems. Develops and assesses alternative solutions as necessary. Makes appropriate decisions in a timely manner. Analyzes impact of decisions.
• Work is accomplished quickly and accurately. Takes responsibility for actions. Prioritizes work effectively and uses time efficiently. Accomplishes goals and objectives.
• Makes/fulfills commitments. Consistently works independently, meets deadlines, and accepts responsibility for his/her actions. Adheres to all attendance requirements. Prompt, well prepared and ready to contribute.
• Level I LOMA Designation Preferred

Ability to Travel:
None

The expected hiring range for this position is $23.24 - $29.04 hourly for work performed in the primary location (South Portland, ME). This expected hiring range covers only base pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting base pay will be based on several factors including work location, job‑related skills, experience, qualifications, and market conditions.

These ranges may…