Claims Specialist - Operations

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