PLADS (LTD) Claims Technical Lead

Accountabilities:

• Act as a primary technical resource for case managers, answering claims-specific questions and providing guidance on appropriate case-management and risk-management practices.
• Mentor new employees, support onboarding and training activities, and contribute to refresher training and ongoing professional development for existing team members.
• Conduct claim reviews and audits as needed to assess quality, consistency, and adherence to appropriate claims-management practices.
• Provide coaching and constructive feedback to case managers, helping improve decision-making, case outcomes, service quality, and technical capabilities.
• Monitor key performance indicators, service levels, and operational commitments, partnering with case managers and leadership to address performance gaps.
• Monitor workload distribution and make adjustments to support balanced caseloads and effective team performance.
• Support management with team meetings, huddles, operational communications, and discussions focused on performance and service delivery.
• Periodically manage complex claims and customer escalations, applying sound judgment and strong case-management expertise to reach appropriate outcomes.
• Identify emerging trends, recurring issues, and coaching opportunities and communicate them to the leadership team for action.
• Contribute to special projects, process improvements, and ad hoc initiatives that support operational effectiveness and organizational priorities.
• Maintain a strong customer-focused approach while promoting consistent practices, accountability, and continuous improvement across the claims function.

Requirements:

• Bachelor’s degree in health administration, business, or a related field is required, or an equivalent combination of education and professional experience.
• At least 4 years of job-related experience, including a minimum of 2 years of case-management experience in Short-Term Disability (STD), Long-Term Disability (LTD), Life, Absence Management, or a related insurance or benefits environment.
• Strong understanding of insurance contracts, benefit plans, products, and claims-management practices.
• Demonstrated knowledge of effective case-management and risk-management techniques, with the ability to apply sound judgment to complex situations.
• Excellent critical-thinking, analytical, and decision-making skills, with the ability to assess claims and determine appropriate courses of action.
• Strong leadership, organizational, and workload-management capabilities, including the ability to mentor and influence others without relying solely on formal authority.
• Excellent verbal, written, and presentation skills, with the ability to communicate clearly with case managers, leadership, and customers.
• Ability to champion change, identify improvement opportunities, and encourage adoption of effective practices.
• Strong coaching and feedback skills, with a demonstrated ability to support employee development and strengthen team performance.
• Ability to monitor KPIs, interpret operational trends, and translate performance information into practical actions.
• Strong customer-service orientation, integrity, adaptability, and commitment to supporting organizational goals and diverse populations.
• Comfortable working independently in a fully remote environment while collaborating effectively with distributed teams.

Benefits:

• Salary range: $75,000–$95,000 annually, with compensation determined by factors such as experience, education, certifications, geographic location, and other relevant considerations.
• Remote work: Fully remote position for employees working from home within the continental United States, with occasional office attendance possible based on business needs.
• Medical, dental, and vision insurance options.
• Prescription drug coverage.
• Health care and dependent care flexible spending accounts.
• Supplemental accident, cancer, critical illness, and hospital indemnity coverage at no cost to employees.
• 401(k) retirement plans.
• Annual bonus opportunities and an opportunity to purchase company stock.
• Up to 20 days of paid time off annually, plus 11 paid holidays.
• Eligible employees may receive state-mandated sick leave and other applicable leaves of absence.
• Adoption and parental leave, where applicable.
• Additional leave programs designed to support employees’ physical, financial, and emotional well-being.
• Opportunities for professional development, mentoring, training, and continued career growth.