Location
Noida | India
Job description
- 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 physician s 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 disability s 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
- Any other essential function that may occur from time to time as directed by the Supervisor.
- Primary Internal Interactions
- UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
- Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
- Subject Matter Expert for the purpose of work thread related issues and escalated transactions
- QCA for the purpose of feedback and internal Performance Guarantee quality audit team
- Trainers for the purpose of Pre-process and Process DCA training
- Disability Customer Advocates for escalation resolution
Technical Skills
Soft skills (Mandatory / Desired)
- Communication skills - should be able to read, interpret
- business documents. Good verbal/written communication
- Proficiency in English - Spoken and Written
- Analytical and interpersonal skills
- Escalate issues if required
- Data gathering ability/ Eye for detail
- Team work/ Managing Self / Adaptability
- Ability to work successfully in production driven
- environment
- Adaptability to change
- Ability to work on routine/standardized transactions
Desired:
- Self disciplined and result oriented
- Ability to multi task
- Ability to work effectively as part of a team
- Knowledge of Medical Terminology (preferred but not
- compulsory)
Preferred:
- Claims, specifically disability, preferred
- Working knowledge of FMLA/Disability/Leave procedures
- preferred
- Knowledge of system applications preferred
Job tags
Salary
