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PLADS Claims Technical Specialist


Location: Remote - US only

Job Type: Full time


Job Summary

Serves as the claim and/or leave subject matter expert providing support to the Operations leadership team as well as a mentor for case managers.

Principal Duties & Responsibilities

  • Acts as a main point of contact for claims specific questions for the case managers

  • Serves as a mentor for new hires as well as supports new hiring training

  • Takes an active role in refresher training and developing of existing staff

  • Ensures case managers are utilizing appropriate risk management skills to secure the appropriate claim outcome

  • Conducts manager reviews/ audits of claims as necessary to ensure overall quality

  • Provides the appropriate coaching and feedback to case managers as needed

  • Monitors KPIs and reports to ensure service levels and commitments are met, working with case managers as needed

  • Monitors and adjusts workload balancing for case managers

  • Provides support to the manager in facilitating team meetings/ huddles

  • May periodically manage very complex cases directly

  • Elevates any trends and / or coaching opportunities to the leadership team
  • May manage customer escalations

  • Completes special projects and/or ad hoc assignments as requested by the leadership team

  • Performs other related duties as required

Education & Experience Required

  • Bachelor’s Degree in a related field
  • 5 years minimum industry experience
  • 2 years minimum working with Employees

Or an equivalent combination of education and experience

Job Knowledge & Skills

  • Ability to influence and champion change

  • Excellent critical thinking and decision -making skills

  • Strong leadership and organizational skills

  • Excellent Communication skills (verbal, written & presentation)

  • Strong understanding of contracts, plans and products

  • Strong knowledge of best practices and effective case management skills


Acting with Integrity - Clearly states goals and beliefs; lets people know his/her true intentions; does what he she said they would do; follows through on commitments

Communicating Effectively - Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener

Pursuing Self-Development - Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities

Serving Customers - Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages customer expectations

Supporting Change - Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial

Supporting Organizational Goals- Actively supports organizational goals and values; demonstrates enthusiasm toward the company's goals and mission; aligns actions around organizational goals

  • Working with Diverse Populations - Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds