Metlife
Location
Noida | India
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 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
Job tags
Salary
