PLADS Claims Support Specialist (Appeals)
- Acting with Integrity
- Communicating Effectively
- Pursuing Self-Development
- Serving Customers
- Supporting Change
- Supporting Organizational Goals
- Working with Diverse Populations
- Strong attention to detail and accuracy when handling confidential and time-sensitive information.
- Ability to follow standardized procedures, written instructions, and established workflows.
- Proficiency with basic office technology, including email, document management systems, and fax/scanning equipment.
- Working knowledge of Microsoft Office applications (Word, Outlook; Excel preferred).
- Effective written and verbal communication skills for interacting with internal teams and providers.
- Ability to manage multiple tasks, prioritize workload, and meet deadlines.
- Dependable, organized, and able to work both independently and as part of a team.
- Some administrative experience preferred
- Computer skills including but not limited to: Outlook, Excel, and Word are required
- High School Diploma or Equivalent
- One or more years of job-related work experience
- Prior administrative, clerical, or customer support experience in the insurance industry.
- Copies, assembles, and distributes claim files and related documentation upon request, ensuring compliance with privacy and confidentiality requirements.
- Creates, sets up, and inputs new disability claims and/or leave of absence cases as requested, accurately entering data into designated systems and verifying required information.
- Prepares, processes, and distributes outgoing correspondence, including mailings, emails and faxes, and performs manual updates to correspondence as needed.
- Maintains, organizes and updates departmental files, records, templates, and logs to ensure information is current and accessible.
- Conducts outreach to providers and members via telephone, email, and fax to obtain outstanding information and support timely claim and leave processing.
- Completes daily administrative tasks for the team, including faxing, scanning, document preparation, email responses, and tracking follow-up items.
- Assists with assigned special projects and routine operational support activities under direction.
- Follows established workflows, service level expectations, and quality standards while meeting productivity and accuracy requirements.
- Assist with other administrative duties as needed to support department operations and business needs.
- Performs other related duties as required.
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