Sr. Disability and Leave Management Claims Examiner

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential?

Equitable is looking for an experienced Claims Specialist supporting Disability and Leave Management claims to join our team! The Claims Specialist is responsible for providing excellent customer service. You will be expected to utilize judgment and assess risk as you work with various business partners to render claim decisions and partner with internal and external resources. Reliability and dependability throughout our extensive training program is required.

Key Job Responsibilities

• Deliver an exceptional customer experience and ensure that customer commitments and deliverables are achieved
• Communication 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 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 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 procedure 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.

The base salary range for this position is $60,000 - $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.

Equitable Pay and Benefits : Equitable Total Rewards Program

Required Qualifications

• Bachelor's degree or equivalent work experience
• 3 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

Preferred Qualifications

• Group Disability Claims experience
• Prior experience managing Paid Family Leave products for multiple states
• Experience working with the Fineos Claim Management System
• Exceptional written and oral communication skills demonstrated in previous 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 urg