Paid Family & Medical Leave Claims Adjuster

Cross Insurance•New Gloucester, ME

30d

About The Position

The Cross Family of Agencies welcomes you. We need your talent and expertise. Position Requirements: High school graduate required; BA/BS degree or relevant experience preferred. Self- motivated with the ability to work independently in a fast-paced environment with minimal supervision is necessary. Excellent customer services skills are important. There will be frequent interactions with employers and employees requesting leave. The claim’s handler will need to interact with employers and their employees requesting leave benefits in a prompt, courteous, professional manner. Accurate claims adjudication by assessing all relevant information to determine compensability. The applicant will be expected to make decisions whether the leave request should be paid or denied in a timely fashion and communicate same to the appropriate parties. If benefits are due, the applicant will be expected to calculate the accurate benefit payment and notify the proper parties in a timely manner. If benefits are denied the decision will need to be communicated to the proper parties and respond to any appeals. Minimum 3 years experience handling disability and paid leave claims. Experience handling Massachusetts Paid Family and Medical Leave preferred. Stay up to date on changes in the leave law and best practices with leave programs and comply with all state mandated and contractual requirements. Detail oriented with highly developed organizational skills and ability to multitask required. Excellent analytical, problem-solving abilities required. Computer skills are important and should be proficient working in Adobe, Outlook, Excel, Word and not intimidated by learning new programs. Mathematical aptitude is necessary as the position will be required to calculate benefit payments for those cases that qualify. Solid understanding of proper benefit calculation with knowledge of which offsets or coordination of benefits with other coverage may apply. These benefits will need to be calculated accurately and timely. Valid driver’s license, effective transportation and ability to attend onsite customer meetings as needed. Primary Accountabilities: Be the first and founding employee in a new product line utilizing an entrepreneurial approach leading to professional success and growth. Ability to apply expertise and knowledge to the role as the workflow and functions become clearer as the law and it’s implementation go into effect and flexibility to adapt as they may change over time. Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures. Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures. Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations. Positive and effective co-worker relations: Focus on team goals and objectives Courteous and considerate communications Accurate assistance and support to others as needed. The above describes the primary functions of this position; however, should not be considered a detailed description of all assigned tasks. Family Owned From starting at the kitchen table of Woodrow Cross, to becoming one of the largest insurance providers in New England, we’ve grown rapidly over the past 65 years. We’ve still held on to our core values of integrity, hard work, and dedication, and are still privately held. Our offices inspire a culture of community by supporting causes they stand behind. From fundraising for local food banks, to volunteering at after school programs, we’re proud of the many ways our offices find to give back. Initiatives vary from branch to branch to better serve the individual communities they are located in.

Requirements

High school graduate required; BA/BS degree or relevant experience preferred.
Self- motivated with the ability to work independently in a fast-paced environment with minimal supervision is necessary.
Excellent customer services skills are important.
Minimum 3 years experience handling disability and paid leave claims.
Detail oriented with highly developed organizational skills and ability to multitask required.
Excellent analytical, problem-solving abilities required.
Computer skills are important and should be proficient working in Adobe, Outlook, Excel, Word and not intimidated by learning new programs.
Mathematical aptitude is necessary as the position will be required to calculate benefit payments for those cases that qualify.
Solid understanding of proper benefit calculation with knowledge of which offsets or coordination of benefits with other coverage may apply.
Valid driver’s license, effective transportation and ability to attend onsite customer meetings as needed.

Nice To Haves

Experience handling Massachusetts Paid Family and Medical Leave preferred.

Responsibilities

Accurate claims adjudication by assessing all relevant information to determine compensability.
Make decisions whether the leave request should be paid or denied in a timely fashion and communicate same to the appropriate parties.
Calculate the accurate benefit payment and notify the proper parties in a timely manner.
Communicate benefit decisions to the proper parties and respond to any appeals.
Stay up to date on changes in the leave law and best practices with leave programs and comply with all state mandated and contractual requirements.
Be the first and founding employee in a new product line utilizing an entrepreneurial approach leading to professional success and growth.
Apply expertise and knowledge to the role as the workflow and functions become clearer as the law and it’s implementation go into effect and flexibility to adapt as they may change over time.
Gains basic knowledge of Department Errors and Omissions Exposures and implementation of Department E&O Procedures.
Ensures optimum performance in this function and recommends and implements techniques to increase productivity or department procedures.
Develops and maintains an image of corporate excellence and teamwork with emphasis on professional and credible customer service and company relations.
Focus on team goals and objectives
Courteous and considerate communications
Accurate assistance and support to others as needed.