PLADS (LTD) Claims Technical Lead

Job description

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. How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. #LI-CL1 This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a PLADS (LTD) Claims Technical Lead based in United States. This remote leadership role provides technical guidance and operational support across Long-Term Disability (LTD) claims management.You will serve as a trusted resource for case managers, helping them navigate complex claims, risk decisions, and case-management practices.The role combines claims expertise, coaching, quality oversight, KPI management, and continuous improvement.You will help strengthen service quality by auditing claims, identifying trends, and providing actionable feedback.The position also offers opportunities to support training, manage escalations, and contribute to broader operational initiatives.Success requires strong judgment, communication, organization, and the ability to influence change across a claims-focused environment.It is an opportunity to make a meaningful impact on both customer outcomes and the effectiveness of the claims team.