Claim Operator Jobs in New Mexico (NOW HIRING)

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.
Absence and Disability Management
Our Absence and Disability Management business helps employers achieve improved health and productivity outcomes with services focused on absence reporting, proactive case management and effective return-to-work support for a variety of employee health risks or conditions, whether related to physical, mental, social or workplace health. Through our leave administration services, LifeWorks provides clients with improved leave compliance to federal, state and municipal regulations as well as company-specific policies.
Employees can be absent from work for a variety of reasons: casual absence, work-related illness and/or injury, or health issues requiring the employee to be away from the work place for an extended period. Our absence management program helps employers strategically manage those absences- focusing on reducing overall costs, realizing administrative efficiency, and enhancing support for employees and employers. All with the goal of returning employees to health and productivity.
Summary
The Case Manager will oversee, manage, process, and adjudicate FMLA, State, municipal and company specific leaves, as well as straightforward and complex STD claims; to determine benefits due pursuant to an STD plan: and to ensure the ongoing processing of claims. To analyze reported Family Medical Leave (FMLA) requests; to make determinations based on Federal and State regulations; to communicate clearly with clients and claimants on all aspects of the claims process; and to ensure that on-going claim management is within Standard Operating Procedures (SOPs) and Service Level Agreements (SLAs).The case manager assesses any barriers to a successful and timely return-to-work and engages with stakeholders to implement strategies to address those identified barriers and support return to work or an appropriate alternative plan.

Summary

The Case Manager will oversee, manage, process, and adjudicate FMLA, State, municipal and company specific leaves, as well as straightforward and complex STD claims; to determine benefits due pursuant to an STD plan: and to ensure the ongoing processing of claims. To analyze reported Family Medical Leave (FMLA) requests; to make determinations based on Federal and State regulations; to communicate clearly with clients and claimants on all aspects of the claims process; and to ensure that on-going claim management is within Standard Operating Procedures (SOPs) and Service Level Agreements (SLAs).The case manager assesses any barriers to a successful and timely return-to-work and engages with stakeholders to implement strategies to address those identified barriers and support return to work or an appropriate alternative plan.

Responsibilities:

• Manage and process FMLA (and other Federal leaves as applicable) Military leaves, State leaves, company specific and STD claims. With regard to FMLA, will manage all DOL category claims; including re-certifications and the 2nd and 3rd opinion processes
• Conduct case assessments, contacting the employee and their manager / HR by telephone or email, to explain the leave management process, employee accountabilities, and gather information for assessment purposes
• Develop and document an understanding of the situation and the factors supporting, as well as inhibiting, a successful return to work for the employee
• Review all relevant information and consult with appropriate MSI resources as required (nurse consultants, health professionals, supervisory team) to confirm decision (approved / denied) recommendationon FMLA, State, Company specific leaves and STD cases
• Analyzes FMLA medical certifications and other medical documentation and ensures claim determination adheres to the required regulatory compliance timeframes
• Informs STD claimants of any documentation needed to process a claim, timeframe requirements, claim's status (e.g. STD approvals, denials, and consults), or any other information necessary to manage a claim
• Determine an appropriate RTW goal with the employee and the employer; as well as, provide active support for the return-to work planning process between the employee and their supervisor and intervene when necessary
• Communicate proactively with the employer's HR representative regarding any case management issues that may impact the workplace and RTW planning
• Will follow all processes as laid out in the Standard Operating Procedures (SOPs), and/or as detailed in trainings/meetings
• Attend Case Management and Disability Management department team meetings and trainings as required
• Other projects and tasks as assigned

Succeeding as a Case Manager requires the following core qualifications and skills

• 2+ years of comprehensive experience in US Leaves and Disability Case Management and knowledge the various legislative requirements
• Strong interpersonal and helping skills along with superior assessment andproblem solvingskills
• Excellent computer skills and the ability to work primarily online in a paperless environment
• Associate's Degree: you have a registered professional status within the disability management or professional health sector
• Additional course work in occupational health, rehabilitation, legislation related to disability management, helping relationship skills, mediation, human resource management, disability insurance, psychological and workplace factors in disability would be an asset
• Bilingual (English and Spanish) considered an asset
• Management of ADA / ADAAA claims, considered an asset

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A bit about us

We're a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world.

TELUS Health is an Equal Opportunity Employer that aims to foster an inclusive culture that embraces diversity. It is our policy to hire without regard to race, color, creed, religion, national origin, citizenship status, sex, marital status, age, disability, sexual orientation or veteran status.We offer accommodation for applicants with disabilities, as required, during the recruitment process.

By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies' Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.