Key Responsibilities and Required Skills for Disability Payment Specialist

🎯 Role Definition

The Disability Payment Specialist is a benefits and claims professional responsible for accurately adjudicating disability claims, administering recurring and one-time disability payments, reconciling accounts, and ensuring regulatory and program compliance. This role requires strong case management, benefits policy knowledge (including SSDI/SSI and employer-sponsored disability plans), payment processing expertise, and clear stakeholder communication with claimants, providers, internal teams and auditors. The ideal candidate balances meticulous attention to detail with empathetic claimant service, while driving operational efficiencies and maintaining strict confidentiality (HIPAA/PII).

📈 Career Progression

Typical Career Path

Entry Point From:

Benefits Administrator / Benefits Coordinator
Claims Processor / Claims Assistant
Payroll Specialist with benefits exposure

Advancement To:

Senior Disability Payment Specialist
Disability Claims Supervisor / Team Lead
Benefits Manager or Claims Operations Manager

Lateral Moves:

Leave of Absence Specialist
Return-to-Work Coordinator
Workers’ Compensation Specialist

Core Responsibilities

Primary Functions

Manage end-to-end disability payment processing for short-term and long-term disability programs, ensuring accurate benefit calculations, timely disbursement, and reconciliation across payroll and benefit systems to minimize payment errors and claimant disruption.
Adjudicate disability claims by reviewing medical records, treating provider statements, functional capacity reports and eligibility criteria to determine benefit entitlement in accordance with policy, contract terms and applicable law (e.g., SSDI/SSI integration).
Validate claimant eligibility and benefit amounts by applying complex benefit rules, offset calculations (e.g., Social Security, workers’ compensation), salary continuation policies and coordination-of-benefits provisions to produce accurate payment schedules.
Investigate and resolve payment exceptions, overpayments and underpayments through root-cause analysis, corrective payment adjustments, recovery plans and claimant communications, documenting case notes and financial impact.
Perform ongoing case management for active claimants, including routine reviews, re-certifications, payee updates, status changes and coordination of return-to-work or transition plans with HR, payroll and vocational rehabilitation teams.
Liaise with external stakeholders—medical providers, social security offices, third-party administrators, insurance carriers and legal counsel—to obtain medical documentation, clarify benefit determination and support appeals or litigation as needed.
Calculate retroactive payments, lump-sum settlements and pro-rated benefits using payroll data, hire dates, salary history and applicable policy language; coordinate payment timing and tax treatment with payroll and accounting teams.
Reconcile monthly and quarterly payment registers, general ledger entries and bank reconciliation reports to ensure financial integrity of the disability benefits program and prepare variance explanations for finance and audit.
Administer overpayment recovery processes including claimant notification, repayment plan setup, offsets, and coordination with collections teams while ensuring compliance with regulatory and contractual constraints.
Maintain strict privacy, confidentiality and security of claimant information, applying HIPAA, GDPR (where applicable) and internal data protection policies during intake, documentation and electronic transmission of records.
Support appeals and grievances by assembling evidence files, drafting position statements, preparing hearing exhibits and coordinating internal subject matter experts to defend benefit determinations at internal reviews or external hearings.
Monitor and implement policy, regulatory and program changes (e.g., Social Security milestone changes, state disability mandates), updating procedures, training materials and system configurations to maintain program compliance.
Use claims management and benefits administration systems to input decisions, update claim statuses, generate letters, and produce audit-ready documentation; recommend system enhancements to improve throughput and data quality.
Produce regular management reporting and KPI dashboards (e.g., timeliness of determinations, payment accuracy rate, claim backlog, average days to pay) to support continuous improvement and executive decision-making.
Participate in internal and external audits by preparing documentation, responding to audit findings, and implementing remediation plans to address control gaps and strengthen program governance.
Educate claimants about benefit entitlements, payment timing, tax implications and program rules through clear written and verbal communications, balancing empathy with accurate policy guidance.
Train and mentor junior specialists and cross-functional colleagues on best practices for benefit calculations, documentation standards and system workflows to ensure consistent program administration.
Support project workstreams to automate repetitive payment tasks, implement straight-through processing rules and design workflows to reduce manual intervention and improve speed to pay.
Conduct quality assurance reviews and peer audits of adjudication decisions and payment calculations to identify systemic issues, provide corrective feedback and maintain high service quality standards.
Coordinate with payroll and accounts payable to schedule disbursements, resolve payment exceptions and ensure proper general ledger coding, tax withholding and reporting for disability payments.
Evaluate medical documentation for functional limitations and return-to-work capacity, and collaborate with occupational health or vocational rehabilitation partners to transition claimants appropriately while preserving benefit compliance.

Secondary Functions

Support ad-hoc data requests and exploratory data analysis.
Contribute to the organization's data strategy and roadmap.
Collaborate with business units to translate data needs into engineering requirements.
Participate in sprint planning and agile ceremonies within the data engineering team.
Assist with periodic policy reviews and updates to claimant communications, letters and FAQs to improve clarity and reduce inbound inquiries.
Participate in cross-functional projects to integrate benefit systems, streamline workflows and support digital onboarding or self-service portals for claimants.
Provide training sessions and job aids for new hires and business partners on disability payment processes, case documentation standards and system navigation.

Required Skills & Competencies

Hard Skills (Technical)

Expertise in disability benefits administration (short-term disability, long-term disability, SSDI/SSI coordination) and benefit offset calculations.
Strong claims adjudication experience, including medical file review, functional assessment interpretation and appeals preparation.
Proficiency with claims and benefits administration systems (TALX, Sedgwick, ADP, Workday Benefits, or comparable case management platforms) and experience configuring workflows.
Advanced Excel skills (pivot tables, VLOOKUP/XLOOKUP, INDEX/MATCH, complex formulas) for payment reconciliation and reporting.
Familiarity with payroll systems and general ledger reconciliation to coordinate benefit disbursements and accounting entries.
Knowledge of regulatory and compliance frameworks impacting disability benefits (HIPAA, state disability laws, SSA rules).
Experience with overpayment recovery processes, repayment plans, offsets and collections coordination.
Comfort working with document management systems and e-signature workflows to manage claimant paperwork securely.
Ability to produce and interpret KPI dashboards and management reports, using tools such as Power BI, Tableau or equivalent.
Basic SQL or data-querying skills for extracting claims and payment data to support analysis and audits.
Understanding of tax implications of disability payments (taxable vs. non-taxable benefits) and coordination with payroll/tax teams.
Experience participating in audits and remediation activities, including preparing audit evidence and implementing corrective action.

Soft Skills

Exceptional attention to detail and accuracy in calculations and documentation.
Strong written and verbal communication skills for claimant interactions, medical provider outreach and internal reporting.
Empathy and professional customer service orientation when handling sensitive disability cases and claimant concerns.
Critical thinking and problem-solving to investigate complex payment exceptions and make defensible determinations.
Time management and prioritization skills to manage caseloads, deadlines and audit requests.
Team collaboration and stakeholder management across HR, payroll, legal and external vendors.
Adaptability and continuous improvement mindset to refine processes and adopt automation.
Integrity and discretion in handling confidential personal and medical information.
Training and coaching ability to upskill colleagues and share best practices.
Resilience and composure under pressure during high-volume periods or escalations.

Education & Experience

Educational Background

Minimum Education:

High school diploma or equivalent; post-secondary certificate in benefits administration, payroll, or related field preferred.

Preferred Education:

Bachelor’s degree in Business Administration, Human Resources, Social Work, Public Administration, Health Administration or related discipline.

Relevant Fields of Study:

Human Resources
Business Administration
Social Work
Health/Medical Administration
Finance / Accounting (for payment reconciliation roles)

Experience Requirements

Typical Experience Range: 2–5 years of direct experience administering disability benefits, claims adjudication or payroll/benefits coordination.

Preferred:

3–5+ years handling disability claims or benefits administration in an employer, insurance, third-party administrator or government setting.
Demonstrated experience with appeals handling, overpayment recovery and compliance/audit participation.
Prior exposure to SSDI/SSI coordination, state disability programs or insurance carrier workflows is a strong plus.