Claims Associate

Job Description

Job Description

Job Title : Claims Associate

Reports To : Operations Manager

FLSA Status : Non-Exempt

Job Location : As a remote-first organization, employees are expected to primarily work within reasonable driving commute to our main office locations (Roseville CA, Atlanta GA, Phoenix AZ, and Oklahoma City, OK) to meet the requirements of team gatherings, one-off meetings, and company-wide events, as well as the legal, tax, and security regulations based on our business operations.

Note : We do not have a physical office location in Oklahoma City at present (but we may acquire one in the future). Therefore, initially this position would be fully remote. Employees are expected to live within a reasonable driving commute of the Oklahoma area and report to the office bi-weekly if an office is acquired in Oklahoma City in the future.

As a Claims Associate, you’ll gain expertise in Gold Standard service delivery by administering Short-Term Disability and Paid Family Leave claims and ensuring they are paid timely and accurately.

Job Duties and Essential Functions :

• Administer a full workload of disability and / or leave pay claims for multiple (8+) clients per client policies and plan guidelines. Claims administration includes, but is not limited to :
• Confirming plan eligibility and whether a claim is payable;
• Reviewing medical documentation and communicating with healthcare providers;
• Opening / approving / extending / closing claims :
• Drafting letters to be sent to employees regarding disability benefits, including denial letters;
• Calculating reductions :
• Maintaining high-quality employee disability claim files according to set standards and naming conventions; and
• Providing excellent customer service by processing payments in a thorough and timely manner.
• Collaborate with Employee Success team members by answering questions regarding pay eligibility, documentation required, client policies, and benefits.
• Communicate regularly with Employee Success team members, Team Leads, employees, and client contacts to ensure the accurate coordination between client leave compensation pay and other income replacement benefits.
• Weekly self-audits; claim status reports sent to manager with explanation of any outliers.
• Able to take on additional work with short notice (e.g. client needs to be taken over on short notice due to business needs).
• When required, coordinate between short-term disability insurance carriers, worker’s compensation insurance providers, and the employee.
• Participate in client meetings, company-wide off-site meetings, and training programs which may require some infrequent travel.
• Available to back up multiple accounts.
• Perform other duties as assigned in order to meet business needs.
• Expected to work 40 hours per week.
• Expected to report to the office biweekly (if an office is acquired in Oklahoma City in the future)

Perform above duties in the office between regular business hours :

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