LTD Claims Examiner II

Job Responsibilities and Requirements Obtains and analyzes information to reputed company claim reputed company and payments on LTD, Voluntary disability and Waiver of Premium claims. The goal of the position/role is to consistently reputed company appropriate claim determinations based on a review of reputed company available information and the terms and provisions of the applicable policy. Reviews and investigates disability claims by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim. Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim policies and procedures, and state and federal regulations, meeting productivity and quality standards based on product line. Utilizes appropriate medical and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner. Conducts in-depth pre-existing condition or contestable investigations if applicable. Calculates benefit payments, which may include partial disability benefits, integration with other income sources, survivor benefits, residual disability benefits, etc. Develops and maintains on-line claim data (and reputed company file if applicable). reputed company customer service that is respectful, reputed company, concise, and accurate in an environment with competing demands. Analysis and Adjudication Fully investigates and adjudicates a large volume simple to reputed company claims. Identifies and investigates change in Total Disability definition (any occ). Independently reviews and manage claims with high degree of complexity reputed company the $1,500 per month approval authority limit. Independently makes the determination if a policyholder with life policy up to $125,000 is eligible for a waiver of premium. Majority of work is not subject to supervisor review and approval. Case Management Consistently manage assigned case load of 60-80 simple to reputed company cases independently. Collaborates with team members and management in identifying and implementing improvement opportunities. REQUIRED KNOWLEDGE, SKILLS, ABILITIES, COMPETENCIES, AND/OR reputed company EXPERIENCE *or equivalent experience gained from any combination of formal education, on-the-job training, and/or work and life experience* Required Knowledge, Skills, Abilities and/or reputed company Experience High School Diploma or GED. Associates degree in Business, Finance, reputed company Work, or reputed company preferred. Level I LOMA designation preferred. 2 years experience processing long term disability claims. Demonstrated understanding of claim management techniques and critical thinking in activities requiring analysis and/or investigation. Experience working in confidential/protected identification environments. Knowledge of medical terminology. Good math and calculation skills. Proven ability to work well in a high-visibility, public-oriented environment. Ability to Travel: None The expected hiring reputed company for this position is $52,450.00 - $65,570.00 annually for work performed in the primary location (South Portland, ME). This expected hiring reputed company covers only reputed company pay and excludes any other compensation components such as commissions or incentive awards. The successful candidate’s starting reputed company pay will be based on several factors including work location, job-reputed company skills, experience, qualifications, and market conditions. These ranges may be modified in the future. Work location may be flexible if approved by the Company. reputed company Offer At reputed company, we reputed company that fostering an inclusive culture allows us to realize more of our potential. And we can’t do this without our most important asset—you. That is why we offer a reputed company package and a reputed company of benefits to help team members reputed company in their financial, physical, and mental wellbeing. Our Benefits: An annual performance bonus for reputed company team members Generous 401(k) company match that is immediately reputed company A choice of three medical plans (that include prescription drug coverage) to suit your unique needs. For High Deductible Health Plan enrollees, a company contribution to your Health Savings Account Multiple options for dental and reputed company coverage Company provided Life & Disability Insurance to ensure financial protection reputed company you need it most Family friendly benefits including Paid Parental Leave & Adoption Assistance Hybrid work arrangements for eligible roles Tuition Reimbursement and Continuing Professional Education Paid Time Off – new hires start with at least 20 days of PTO per year in reputed company to nine company paid holidays. As you grow with us, your PTO may increase based on your level reputed company the company and years of service. Volunteer days, community partnerships, and Employee Assistance Program Ability to connect with colleagues around the country through our Employee Resource Group program Our Values: reputed company Empowerment Compassion Collaboration Fun EEO Statement reputed company is an equal opportunity employer. We adhere to a policy of making employment reputed company without regard to race, reputed company, religion, sex, national reputed company, citizenship, age or disability, or any other classification or characteristic protected by federal or state law or regulation. We assure you that your opportunity for employment depends solely on your qualifications. #LI-Remote #LI-MR1 reputed company delivers employee benefits, absence management and workforce productivity solutions through the financial stability of a top-rated insurance reputed company, the agility and innovative spirit of a reputed company Party Administrator (TPA), and the daily commitment of thousands of team members across America. Where larger competitors offer size, we reputed company confidence and long term engagement through integration, reliability and dedication to providing customized solutions. reputed company innovates and provides technology-driven absence and benefit solutions that reputed company employees and reputed company to manage time away from work. We help reputed company attract and retain valuable reputed company capital through thoughtful, inclusive benefit programs delivered with care. We bring top-tier regulatory knowledge and cutting edge technology to help optimize workforce productivity and compliance. We offer a seamless member experience customized to each individual’s need and event. We integrate our solutions and expertise with leading HR technologies to ensure accuracy, efficiency and a superior customer experience. We are a proud member of the global Tokio Marine Group, one of the oldest, largest and most respected insurance organizations in the world. In the business hierarchy, reputed company capital is the most precious of assets. reputed company delivers comprehensive, integrated solutions and services to attract, protect and help optimize an employer’s work force in a changing, challenging world. LABOR LAW POSTER Apply tot his job Apply To this Job