Claims Clerk

Claims Clerk - 7 Openings

Location: Winthrop, Maine
Pay Rate: $27.00 per hour
Schedule: Full-Time, 40 Hours per Week
Work Arrangement: Onsite to Start | Hybrid Eligible Upon Successful Training

Position Overview

The Maine Disability Determination Services (DDS) is seeking a detail-oriented and customer-focused Claims Clerk to support the disability claims adjudication process.

In this role, you will assist the adjudicative team by gathering information, obtaining and organizing medical evidence, coordinating communications, and maintaining accurate case documentation. While this position does not make disability determinations, it plays a critical role in ensuring claims are thoroughly documented and efficiently processed.

This is an excellent opportunity for candidates with administrative, claims processing, customer service, medical office, or social services experience who enjoy working in a fast-paced environment where attention to detail is essential.

Key Responsibilities

Claims Support & Evidence Collection

• Contact claimants, healthcare providers, employers, and authorized third parties by phone and mail to obtain medical and vocational documentation.
• Follow up on outstanding requests to ensure timely receipt of records and supporting evidence.
• Collect, organize, review, and prepare medical and psychiatric records for adjudicative review.
• Assist in summarizing and organizing documentation to support disability claim evaluations.

Case Coordination

• Schedule and coordinate medical and psychological consultative examinations as directed by adjudicators and medical consultants.
• Communicate examination details and appointment reminders to claimants.
• Track and document claim-related activities and correspondence.

Customer Service & Communication

• Respond to incoming calls regarding claim status and general inquiries.
• Return voicemails and provide timely, professional assistance to claimants and providers.
• Conduct required survey and follow-up calls.

Records Management

• Review paper claim files and convert records to electronic format.
• Scan, index, and maintain electronic documentation.
• Ensure files are complete, accurate, and organized in accordance with agency requirements.

Minimum Qualifications

Candidates should demonstrate:

• Strong customer service and communication skills
• Basic knowledge of office procedures and administrative practices
• Ability to follow written and verbal instructions
• Ability to manage multiple tasks while maintaining accuracy and attention to detail
• Proficiency with Microsoft Office applications and other computer-based systems
• Ability to perform routine data entry and keyboarding tasks
• Ability to review documents for accuracy and completeness
• Strong organizational and recordkeeping skills
• Ability to work independently and as part of a team

Preferred Qualifications

The following experience is highly desirable but not required:

• Medical records administration
• Medical terminology
• Disability claims processing
• Social Security or public benefits programs
• Healthcare administration
• Insurance, workers' compensation, or claims-related support work
• Electronic document management systems

Knowledge, Skills & Abilities

Successful candidates will have:

• Exceptional attention to detail
• Strong written and verbal communication skills
• Ability to handle sensitive and confidential information
• Professional telephone etiquette
• Strong organizational and time-management skills
• Ability to prioritize work and meet deadlines
• Experience maintaining electronic and paper filing systems
• Ability to learn and apply agency policies and procedures

Schedule & Work Environment

• Full-time, 40 hours per week
• Scheduled between 7:00 AM and 5:00 PM
• No on-call responsibilities
• Hybrid work opportunity available after successful completion of training and demonstrated independent performance

Background Check Requirement

The selected candidate must successfully complete a Tier II Social Security Administration background investigation prior to employment.

Requirements include:

• Fingerprinting
• Identity verification
• A valid government-issued photo ID that is REAL ID compliant