STD Claims Examiner

Accountabilities:: Investigate, evaluate, and adjudicate short-term disability claims promptly and accurately in accordance with policy provisions, departmental procedures, and applicable regulations. Interpret contract provisions related to eligibility, covered weekly earnings, total disability definitions, offsets, pre-existing conditions, and other applicable requirements. Calculate benefit amounts and process financial activities, including payment adjustments, stop payments, voids, check reissues, other-income adjustments, reimbursements, final benefits, and overpayments. Initiate and facilitate case management and coordinate ancillary services to support appropriate claim outcomes. Proactively communicate with claimants, policyholders, physicians, and other stakeholders to obtain information, resolve investigation issues, and manage expectations. Obtain claim information through efficient and appropriate methods while maintaining complete and accurate documentation of claim actions and communications. Coordinate with long-term disability examiners to support appropriate transitions from STD to LTD claims. Engage medical, vocational, Social Security, and other technical resources at appropriate stages of the claim. Support subrogation activities and recovery of applicable amounts from third parties. Escalate claim activity outside established authority levels to supervisors or managers for review. Respond to customer service issues within required timeframes while maintaining a professional, accurate, and courteous service experience. Maintain confidentiality and consistently follow documented workflows, procedures, and unfair claims practice requirements. Meet or exceed departmental service, quality, and production objectives. Collaborate with team members and management to identify process improvement opportunities and communicate relevant client or claims trends. Requirements: Bachelor’s degree or equivalent combination of education and relevant experience. 5+ years of experience managing short-term disability claims with first-pay authority. Strong understanding of short-term disability claims adjudication, policy interpretation, benefit calculations, and claims investigation. Excellent analytical and decision-making skills, with the ability to evaluate complex claim information and reach sound conclusions. Strong mathematical and calculation skills, particularly when determining benefits and other financial adjustments. Excellent customer service and communication skills, with the ability to interact professionally with claimants, policyholders, medical professionals, and internal stakeholders. Strong organizational skills and attention to detail, with the ability to manage multiple claims and deadlines while maintaining accurate documentation. Working knowledge of Microsoft Excel and Word. Ability to maintain confidentiality and comply with established procedures, regulatory requirements, and claims practices. Ability to collaborate effectively with technical resources, colleagues, and management. Spanish fluency, both written and spoken, is a plus. Candidates may be considered at Level I, Level II, or Senior level depending on their experience and qualifications. Benefits: Hourly compensation of $25.96–$43.27, depending on education, experience, geographic location, and other job-related factors. Eligibility for an annual incentive program. Hybrid work arrangement in Indianapolis, Indiana, with potential work-from-home eligibility for candidates in the Portland, Maine area, subject to business needs and workplace policies. Occasional requirement to return to an office in California, Indiana, or Maine for business needs, team building, and collaboration. Medical and prescription, dental, and vision insurance. Health Savings Account and Flexible Spending Account options. Paid time off. 10 weeks of 100% paid parental leave after 12 months of employment. 401(k) plan with company match. Pension plan. Company-paid life and disability insurance. Wellness program and company-paid employee assistance program. Clinic access at eligible locations, including Indianapolis, Charlotte, and Cincinnati. Reasonable accommodations available for qualified employees with disabilities. Employment is subject to applicable regulatory background-check requirements.