Paid Leave Claims Specialist

Key Responsibilities

• Manage new, ongoing, and periodic State-Mandated Disability and Paid Family Leave claims within required regulatory and departmental timeframes.
• Review claimant, employer, medical, and other relevant documentation to determine benefit eligibility, claim duration, and benefits payable.
• Make timely and accurate decisions to approve, pend, or deny assigned claims in accordance with applicable regulations, policy provisions, and departmental procedures.
• Communicate with claimants, policyholders, employers, and healthcare providers by phone and in writing to obtain information necessary for initial and ongoing claim management.
• Prioritize incoming correspondence and assigned work to meet service-level and mandated turnaround requirements.
• Accurately calculate and process applicable benefits and taxes.
• Maintain clear, complete, and accurate claim documentation, including decisions, actions, and customer interactions.
• Identify and escalate complex or unusual claim situations to the appropriate subject matter expert or Claims Supervisor.
• Meet established productivity, financial, and quality standards while maintaining accurate claim decisions and a positive customer experience.
• Review and respond to quality audits and related correspondence.
• Provide prompt, accurate, and courteous service to internal and external customers.
• Collaborate across teams to resolve claim issues and support departmental and organizational objectives.
• Participate in projects, process improvements, and other departmental assignments as needed.
• Strong customer service and communication skills
• Attention to detail and organizational skills
• Technological aptitude and adaptability
• Teamwork and problem-solving abilities
• Knowledge of federal and state laws on leaves of absence
• Ability to evaluate and process disability and leave claims
• Proficiency in Microsoft Excel and Word
• High School diploma required
• College degree or an equivalent of at least three (3) years of work experience preferred
• 1-2 years’ experience in a disability or leave claims environment required

Skills, Knowledge, and Abilities:

Minimum Requirements

Preferred Qualifications

• 2+ years of disability claims or leave administration experience
• Experience administering State-Mandated Disability claims
• Experience with short-term disability, long-term disability, and/or FMLA claims
• Bachelor’s degree or an equivalent combination of education and relevant work experience
• Experience working in a productivity- and quality-measured claims environment
• Schedule Details
• This role operates on a semi-flex 40 hour a week, M-F schedule. All schedules will be approved based on business needs.
• Additional information
• The internal title for this role is Specialist II Claims. #ind123 #LI-AP1
• Employee Benefits: We aim to protect the wellbeing of our employees and their families with a broad benefits offering. In addition to offering comprehensive health, dental and vision insurance, we support emotional wellbeing through mental health benefits and an employee assistance program. Work/life balance is important and Protective offers a variety of paid time away benefits ( e.g., paid time off, paid parental leave, short-term disability, and a cultural observance day). The financial health of our employees is just as important as physical and emotional health. Some of the financial wellbeing benefits include contributions to healthcare accounts, a pension plan, and a 401(k) plan with Company matching. All employees are encouraged to protect their overall wellbeing by engaging in ProHealth Rewards, Protective’s platform to improve wellbeing while earning cash rewards.
• Eligibility for certain benefits may vary by position in accordance with the terms of the Company’s benefit plans.
• Accommodations for Applicants with a Disability: If you require an accommodation to complete the application and recruitment process due to a disability, please email [email protected]. This information will be held in confidence and used only to determine an appropriate accommodation for the application and recruitment process.
• Please note that the above email is solely for individuals with disabilities requesting an accommodation. General employment questions should not be sent through this process.
• We are proud to be an equal opportunity employer committed to being inclusive and attracting, retaining, and growing an inclusive workforce.

Schedule Details

Additional information