Claims Associate

Job Title: Claims Associate

Reports To: Operations Manager

FLSA Status: Non-Exempt

Learn about Gold Standard service delivery while focusing primarily on claim success.

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 two times per month as directed by manager.

Perform above duties in the office between regular business hours:

• Roseville, CA office location: Monday to Friday, 8am to 5pm (PST)


• Atlanta, GA office location: Monday to Friday, 8am to 5pm (EST)


• Phoenix, AZ office location: Monday to Friday, 8am to 5pm (MST)

• A four-year college degree or a professional certification in a similar or related field.


• Proficient typing and strong knowledge of MS Excel and MS Word.


• Always focused on providing excellent customer service.


• Ability to prioritize tasks and focus on the most important ones.


• Ability to communicate effectively with colleagues, leadership, clients, and employees.


• Have a system for keeping track of work to ensure that the work is done on time and accurately.


• Ability to identify and solve problems quickly and efficiently.


• Willing to learn and take on new challenges.


• Takes the initiative to understand the why behind things.


• Receptive to feedback and embraces continuous improvement.


• Planning ahead, managing time well, being on time, and thinking of better ways to do things.


• Being helpful, respectful, approachable and team-oriented, building strong working relationships and contributing to a positive work environment.


• Excellent follow through and common sense.


• Excellent attention to detail.


• Strong organizational, quantitative, and verbal/written communications skills.


• Ability to comprehend a variety of informational documents including, but not limited to, disability plan documents and client leave policies.


• Ability to comprehend and interpret a variety of reference books and manuals including administrative manual, personnel policies, and state and federal regulations.


• Ability to keep abreast of any changes in law, policy, methods, procedures, etc. as they pertain to clients.

Compensation details: 0 Yearly Salary

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