Claims Consultant

Role overview

The Claims Consultant will handle disability and leave-related claim files from review through decision-making. This position focuses on assessing documentation, confirming eligibility, and processing outcomes in line with internal policies and relevant regulations. The role is based in Stone Mountain, GA and is performed remotely.

Key responsibilities

• Examine submitted claim materials and decide whether the case meets eligibility criteria.
• Assess medical records and other supporting evidence to validate the claim.
• Manage claim actions such as approvals, denials, payments, and status updates.
• Keep case files complete, accurate, and properly documented.
• Coordinate with employees, employers, and healthcare providers to gather needed information.
• Refer complex matters for additional review when required.
• Complete assignments accurately while meeting service-level expectations.
• Contribute to quality improvement efforts and follow process and compliance standards.

Qualifications

• At least 1 year of experience in disability claims, leave administration, insurance claims, or a similar area.
• Working knowledge of medical terminology and clinical documentation.
• Prior exposure to claims management software is an advantage.
• Strong reasoning and issue-resolution abilities.
• Clear written and spoken communication skills.
• Comfortable using Microsoft Office tools.
• Able to handle several priorities in a busy, time-sensitive environment.

Additional information

This is a full-time remote role. The position requires accurate decision-making, attention to documentation detail, and ongoing coordination with multiple stakeholders involved in the claims process.