Claims examiner Jobs in Alexandria, VA

Job Classification:

Operations - Insurance Operations

Job Description

Prudential is a company of smart, ambitious professionals working together across a multitude of disciplines. Together, we are building a better financial future for our customers and our communities around the globe. At Prudential, we understand that a company is only as good as its people. This simple fact is central to all that we do.

The Team

You will be part of the Long-Term Disability (LTD) Claims team which is part of our Group Insurance Business. We have Long-Term Disability teams based out of New Jersey, Maine, and Arizona as well as fully remote teams.

The Role

The Long-Term Disability (LTD) Disability Claims Examiner is responsible for providing excellent customer service while managing an assigned block of around 95 to 100 Long-Term Disability claims. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions. As a claim manager you will partner with medical and vocational resources to evaluate disability and support return to work goals. Additional responsibilities include:

• Deliver an exceptional customer experience that serves to differentiate Prudential from our competitors and ensures that customer commitments and deliverables are achieved.

• Review and interpret medical records, utilizing resources as appropriate.

• Complete financial calculations

• Gain an understanding and working knowledge of the Prudential claim system, policies, procedures, and contracts as well as regulatory and statutory requirements for claim products administered.

• Apply contract/policy provisions to ensure accurate eligibility and liability decisions.

• Demonstrate and apply analytical and critical thinking skills.

• Verify on-going 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 the ability to balance multiple priorities.

• Work independently as well as within a team structure.

What You’ll Need to Succeed:

• 2 years minimum of prior Long Term Disability Claim Management or highly relevant experience required

• Exceptional customer service skills

• Proven skills in positive and effective interaction with challenging customers

• Strong written and oral communication skills demonstrated in previous work experience (preference for bilingual verbal communication in Spanish and English)

• 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 team environment.

• Continuous improvement mindset

• A commitment to support a work environment that fosters Diversity and Inclusion

• Strong computer literacy and skills with the ability to work within multiple systems; proficiency with PC based programs such as Excel and Word.

#LI-IN

#LI-Remote

What we offer you:

Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $53,300.00 to $88,000.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills.

• Market competitive base salaries, with a yearly bonus potential at every level.

• Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave.

• 401(k) plan with company match (up to 4%).

• Company-funded pension plan.

• Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs.

• Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development.

• Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs.

• Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period), after one year of service.

Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance.