Previous Job
Group Claims Representative (TX0
Ref No.: 19-08101
Location: Plano, Texas
Group Claims Representative

Address: 1640 Dallas Parkway, Plano, TX 75093
Hours: Monday-Friday 8:00AM-5:00PM
Pay Rate: $14.40/hour paid every Friday
Contract Length: ASAP to 12/31/2020 (permanent placement dependent on attendance and performance)

  • Helps our customers maintain their health, well-being, and sense of security by managing an assigned caseload of disability claims under guidance.
  • Evaluates customer eligibility based on contractual, state, and federal guidelines; communicates decisions in writing, calculates, and issues benefit payments.
  • Follows-up on and reviews Social Security decisions and other income benefits.
  • Helps customers through difficult times by following-up on their medical progression and discussing return to work options.
  • Partners with medical, vocational, and other expert resources to develop a plan to address disability obstacles between the customer, attending physician, and client to facilitate a successful return to work on a full-time or modified-duty basis.
  • Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
  • Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
  • Pays all covered claims accurately and timely
  • Executes on all customer performance guarantees
  • Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
  • Ability to handle potentially high levels of call volume from customers and clients
  • Exhibits claim management performance according to quality and compliance standards
  • Manages both new claims and open claims equally and maintains decision times
  • Adheres to standard timeframes for processing mail, tasks and outliers
  • Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
  • Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed
  • Understands Group Operations and Corporate Compliance, Polices and Procedures and best practices
  • Stays abreast of ongoing trainings associated with role and business unit objectives
  • Exceptional customer service standards and delivery
  • Strong oral and written communication skills
  • Ability to prioritize and multi-task
  • Ability to thrive in a fast-paced environment and meet deadlines
  • Strong math and calculation skills
  • Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
  • Conflict resolution skills
  • Critical attention to detail
  • Team oriented
  • Proficient in Microsoft Office
  • Multilingual skills are highly desired
  • High School Diploma Required
  • BA/BS degree or equivalent work experience preferred
  • Minimum of 1 year disability claim management experience preferred
  • Ability to pass 7-year county background check and urine drug screen