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,

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.