• Primarily engaged either in the processing of our most complex Leave and Disability claims or in project work that supports departmental initiatives. • May assist with distribution/redistribution of work for claims team. • Reviews complex claims and/or related situations. • Make decisions that may require deviating from normal guidelines. • Must use discretion in decision-making ranging from contract interpretation to benefit amounts to be paid. • Actively suggests and operationalizes adjustments to standard work as the need arises. • Participation in Claims-specific or multi-departmental project work as assigned; may be expected to facilitate or act as project manager on smaller-scale initiatives. • Responsible for providing direction, developing, training, and mentoring less experienced claims staff, including completing audits and providing feedback. • May be responsible for managing work queues for assigned team(s), providing direction, prioritization, and reassignment where needed to meet agreements and customer expectations. • Ensures claim controls for KRI, appeal, and general claim handling agreements are followed. • Assists or leads team in developing and implementing improvement processes. • Refer cases to legal and/or may represent company in legal matters surrounding claims decisions. • Other duties and projects as assigned.