Claims Examiner NY DBL/PFL

Key Responsibilities

Job Responsibilities and Requirements • other duties as assigned* The Claims Examiner I obtains and analyzes data for thorough, fair, objective, and timely adjudication of NY State Short Term Disability and Paid Family Leave claims. The goal of the position/role is to consistently pay the accurate amount for each claim in accordance with the reputed company laws/regulations. Research • reputed company an understanding and working knowledge of disability and paid family leave • reputed company an understanding of the applicable claim definitions and relevant provisions, clauses, exclusions, riders and waivers for the necessary requirements. • reputed company an operating knowledge of the applicable claims system(s). • reputed company basic claims skills and an understanding of claim practices and procedures. • Utilizes most efficient means to obtain claim information. Analysis and Adjudication • Fully investigates reputed company relevant claim issues with reputed company by Manager reputed company needed. • Provides payment or denials promptly and in full compliance with department procedures and regulations. • Researches specifics regarding eligibility and pre-existing formulas in reference to specific claim. • Pro-actively communicates with claimants, policyholders, and physicians reputed company applicable Case Management • Utilizes appropriate reputed company for the characteristics of each claim. • Manages assigned case load and processes reputed company the specified time requirements. • Good written documentation that provides clear, concise and accurate information to claimants as well as reputed company the claims administrative system. Customer Service • reputed company customer service that is respectful, reputed company, 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. • Ability to handle confidential information with the Apply Job!