Job Description

We help protect our customers against life’s uncertainties. Regardless of where you work within the company, you’ll be helping provide protection and peace of mind when our customers need it most. As a Paid Leave Claims Specialist, you will help claimants navigate important moments in their lives by delivering timely, accurate, and empathetic claim service. You will manage Paid Leave claims from initial review through ongoing administration, evaluating claimant, employer, and medical information to determine eligibility, claim duration, and benefits payable. This role is well suited for an experienced disability or leave professional who combines sound judgment with strong customer service. You will work in a collaborative, technology-enabled environment where accuracy, regulatory compliance, and responsiveness are essential. 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. 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 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

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

This role operates on a semi-flex 40 hour a week, M-F schedule. n The internal title for this role is Specialist II Claims. #In addition to offering comprehensive health, dental and vision insurance, we support emotional wellbeing through mental health benefits and an employee assistance program. 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. Accommodations for Applicants with a Disability : If you require an accommodation to complete the application and recruitment process due to a disability, please email eric.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.

Job Tags

Temporary work, Work experience placement, Flexible hours

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