Equitable
Sr. Disability and Leave Management Claims Examiner- Group Insurance Claims Expe
Equitable, Charlotte, North Carolina, United States, 28245
Sr. Disability and Leave Management Claims Examiner – Remote (Group Insurance Claims Experience Required)
Join Equitable as a Senior Disability and Leave Management Claims Examiner. This remote position focuses on providing excellent customer service while making accurate, compliant claim decisions.
Key Job Responsibilities
Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
Communicate via telephone, email, and text with employees, employers, attorneys, and others
Review and interpret medical records, utilizing resources as appropriate
Complete financial calculations
Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
Apply contract/policy provisions to ensure accurate eligibility and liability decisions
Demonstrate and apply analytical and critical thinking skills
Verify ongoing liability and develop strategies for return‑to‑work opportunities as appropriate
Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
Leverage a broad spectrum of resources, materials, and tools to render claims decisions
Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
Work within a fast‑paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
Work independently as well as within a team structure
Deliver refresher trainings as appropriate to the claim team
Identify areas for improvement in claims processing, including workflow changes or improving procedures based on trends or challenges observed in claim review
Prepare reports for management on claim outcomes and performance metrics
Assist in training and mentoring junior claim examiners on best practices, improving their decision‑making skills
Oversee the ongoing management of complex, high‑priority or escalated cases and callers
Base Salary & Benefits The base salary range for this position is $60,000 - $65,000, varying with skills, experience, and location. Equitable provides performance‑based compensation, spot bonuses, and short‑term incentive opportunities. Eligible employees receive a full range of benefits, including medical, dental, vision, a 401(k) plan, and paid time off.
Required Qualifications
Bachelor’s degree or equivalent work experience
3+ years disability claims administration experience
Prior leadership experience as a team lead or manager
Exceptional customer service skills
Maintains positive and effective interaction with challenging customers
Strong knowledge of disability and leave laws and regulations
Ability to handle sensitive information with confidentiality and professionalism
Group Disability Claims experience
Prior experience managing Paid Family Leave for multiple states
Preferred Qualifications
Experience working with the Fineos Claim Management System
Exceptional written and oral communication skills demonstrated in prior work experience
Excellent organizational and time‑management skills with ability to multitask and prioritize deadlines
Ability to manage multiple and changing priorities
Detail oriented; able to analyze and research contract information
Demonstrated ability to operate with a sense of urgency
Experience in effectively meeting/ exceeding individual professional expectations and team goals
Demonstrated analytical and math skills
Ability to exercise critical thinking skills, risk management skills and sound judgment
Ability to adapt, problem‑solve quickly and communicate effective solutions
High level of flexibility to adapt to the changing needs of the organization
Self‑motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative environment
Continuous improvement mindsetA commitment to support a work environment that fosters diversity and inclusion
Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Key Skills
Analytical Thinking:
Ability to determine the root cause of problems and develop alternative solutions
Customer Support Operations:
Knowledge of best practices, tools, and technologies for managing a call center
Customer Support Systems:
Proficiency with applications, hardware, software, networking, and support environments
Managing Multiple Priorities:
Effective self‑management and prioritization of concurrent initiatives
Problem Solving:
Familiarity with tools and techniques for recognizing, anticipating, and resolving organizational or process issues
About Equitable At Equitable, we’re a team committed to helping our clients secure their financial well‑being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage employees to leverage their unique talents to become a force for good in our communities.
Equal Employment Opportunity & Accommodation Equitable is committed to providing equal employment opportunities to applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information, or any other class protected by federal, state, and local laws. Equitable participates in the E‑Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at (212) 314‑2211 or email TalentAcquisition@equitable.com.
Primary Location:
United States – Remote
Other Locations:
United States – NC, Charlotte; United States – NY, Syracuse
Schedule:
Full‑time
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Key Job Responsibilities
Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
Communicate via telephone, email, and text with employees, employers, attorneys, and others
Review and interpret medical records, utilizing resources as appropriate
Complete financial calculations
Gain an understanding and working knowledge of the Equitable claim and other applicable systems, policies, procedures, and contracts as well as regulatory and statutory requirements for claim adjudication
Apply contract/policy provisions to ensure accurate eligibility and liability decisions
Demonstrate and apply analytical and critical thinking skills
Verify ongoing liability and develop strategies for return‑to‑work opportunities as appropriate
Document objective, clear and technical rationale for all claim determinations and demonstrate the ability to effectively communicate claim decisions to our customers via oral and written communication
Leverage a broad spectrum of resources, materials, and tools to render claims decisions
Provide timely and exceptional customer experience by paying appropriate claims accurately and timely, responding to all inquiries and maintaining expected service and quality standards
Work within a fast‑paced environment, with tight deadlines, and demonstrate the ability to balance multiple priorities
Work independently as well as within a team structure
Deliver refresher trainings as appropriate to the claim team
Identify areas for improvement in claims processing, including workflow changes or improving procedures based on trends or challenges observed in claim review
Prepare reports for management on claim outcomes and performance metrics
Assist in training and mentoring junior claim examiners on best practices, improving their decision‑making skills
Oversee the ongoing management of complex, high‑priority or escalated cases and callers
Base Salary & Benefits The base salary range for this position is $60,000 - $65,000, varying with skills, experience, and location. Equitable provides performance‑based compensation, spot bonuses, and short‑term incentive opportunities. Eligible employees receive a full range of benefits, including medical, dental, vision, a 401(k) plan, and paid time off.
Required Qualifications
Bachelor’s degree or equivalent work experience
3+ years disability claims administration experience
Prior leadership experience as a team lead or manager
Exceptional customer service skills
Maintains positive and effective interaction with challenging customers
Strong knowledge of disability and leave laws and regulations
Ability to handle sensitive information with confidentiality and professionalism
Group Disability Claims experience
Prior experience managing Paid Family Leave for multiple states
Preferred Qualifications
Experience working with the Fineos Claim Management System
Exceptional written and oral communication skills demonstrated in prior work experience
Excellent organizational and time‑management skills with ability to multitask and prioritize deadlines
Ability to manage multiple and changing priorities
Detail oriented; able to analyze and research contract information
Demonstrated ability to operate with a sense of urgency
Experience in effectively meeting/ exceeding individual professional expectations and team goals
Demonstrated analytical and math skills
Ability to exercise critical thinking skills, risk management skills and sound judgment
Ability to adapt, problem‑solve quickly and communicate effective solutions
High level of flexibility to adapt to the changing needs of the organization
Self‑motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative environment
Continuous improvement mindsetA commitment to support a work environment that fosters diversity and inclusion
Proficiency in computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word
Key Skills
Analytical Thinking:
Ability to determine the root cause of problems and develop alternative solutions
Customer Support Operations:
Knowledge of best practices, tools, and technologies for managing a call center
Customer Support Systems:
Proficiency with applications, hardware, software, networking, and support environments
Managing Multiple Priorities:
Effective self‑management and prioritization of concurrent initiatives
Problem Solving:
Familiarity with tools and techniques for recognizing, anticipating, and resolving organizational or process issues
About Equitable At Equitable, we’re a team committed to helping our clients secure their financial well‑being so that they can pursue long and fulfilling lives. We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage employees to leverage their unique talents to become a force for good in our communities.
Equal Employment Opportunity & Accommodation Equitable is committed to providing equal employment opportunities to applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information, or any other class protected by federal, state, and local laws. Equitable participates in the E‑Verify program. If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at (212) 314‑2211 or email TalentAcquisition@equitable.com.
Primary Location:
United States – Remote
Other Locations:
United States – NC, Charlotte; United States – NY, Syracuse
Schedule:
Full‑time
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