Claims Specialist - Operations

Job Description

Basic Function Handle and administer Family & Medical Leave Act standalone (as well as other leave) claims and adhere to federal and state regulatory and/or company plan requirements and established FMLA workflow procedures Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems. Promptly review new FMLA and other leave claims within regulatory timelines, evaluate against appropriate leave plans and make initial claim decision. Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc. Update systems to accurately reflect leave status and ensure appropriate diary documentation exists Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures The position is expected to do absence management and adjudication on Federal, State and company leaves. Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physicians office Essential Functions: Analyze, validate and process transactions as per Desktop procedures (L3 & L4) Analyze and research all discrepancies Research & Investigate and resolve outstanding items Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls Establish action plans for each file to bring claims to resolution Utilize internal and external specialty resources to maximize impact on each claim file Use PC programs to increase productivity and performance Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence Work as a team member to meet office goals to obtain disabilitys vision while demonstrating core values and meeting key measures Ensure adherence to established attendance schedules Close visual activity - viewing a computer terminal and extensive reading To apply call Miss Jaspreet Kaur at 9667037957