Obtains and analyzes information to make claim decisions and payments on LTD, Voluntary disability and Waiver of Premium claims.
Reviews and investigates disability claims by using telephone and written contact with the applicable parties, 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.
Utilizes appropriate medical and risk resources, adhering to referral policies, 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 paper file if applicable).

High School Diploma or GED.
Associates degree in Business, Finance, Social Work, or Human Resources 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.

An annual performance bonus for all team members
Generous 401(k) company match that is immediately vested
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 vision coverage
Company provided Life & Disability Insurance to ensure financial protection when 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 addition to nine company paid holidays.
Volunteer days, community partnerships, and Employee Assistance Program
Ability to connect with colleagues around the country through our Employee Resource Group program

Claims Examiner II

Key skills