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.
