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Claim Services Specialist

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Job Order #: 5626699

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Employer Job Number: GO-00539283
Facility: 3sHealth
Job Description: We're seeking a collaborative & innovative leader with experience in disability claims management & benefit services. Reporting to the Claims Services Manager, the Specialist is responsible for the delivery of world class customer service to over 80 health care employers & 40,000 active plan members.

The Specialist acts with considerable independence, discretion, judgement & initiative while providing training & support to the Claim Services team. The Specialist is responsible for the quality & delivery of established disability plans, protocols & services. The Specialist plays an active role in developing disability case management best practice; ensures consistent application in the daily work of the team; & responds to complex inquiries by interpreting benefit plan policies & procedures.

Working collaboratively with other Benefit Specialists & Managers, the Claims Services Specialist performs cross-functional duties in support of the greater Employee Benefits team. The Specialist works closely with stakeholders, ensuring employee benefits are administered for the betterment of plan members.

The Specialist undertakes research projects; provides education & seminars to plan administrators; & assists in compiling & analyzing reports to monitor the trends & experience of the benefit plans. The Specialist writes briefing notes & other communications to provide information & support the decision making of 3sHealth senior leadership, Board of Trustees, committees & stakeholders. Working with the Manager, the Specialist reviews files in preparation for medical & legal review.

Through setting & monitoring the service standards of the department & by ensuring quality at every step of the way, the Specialist works with the team to remove barriers & ensure that customers receive efficient & tim
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