Specialist

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   or employer through outgoing calls, email  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.