Fmla Claims Examiner Jobs (NOW HIRING)

You are:

The Leave Administation Specialist for non-occupational and workers' compensation leaves, responsible for the proactive management of claims. This includes investgating initial claims, leave revalidation, facilitating return-to-work efforts, coordinate employee payroll and time tracking while on leave, and working with work site managers and/or human resources personnel for workplace accommodations according to restrictions implemented by employees' treating physicians.

You will:

• Autonomously manage a dailytask listwithin turnaround time expectations.

• Investigate initial claims for approval underFMLA, PPL, STD (Preg/Maternity cases), and WC programs.

• Support Nurse Case Manager in administering leaves underSTD, LTD, FMLA, PPL, ADA, and WC Programs.

• Interpret and correctly apply provisions of STD, LTD, FMLA, PPL, ADA, and WC Plans.

• Determineif requested time-off is within acceptable guidelines. Request medical records from attending physician,completingnon-complexoutreach to physician offices,and consultingwith nursing staff.

• Supportthe Nurse Case Manager inthereturn-to-work process withtheemployee, human resources, supervisor, andthird-partyvendoruntilthe employee isreleasedtofull duty.

• Assist LTD claimant with Social Security filing(s) and Medicare approval.Update LTD claims for Social Security Award status.Audit and sign-off on coworkers' LTD calculation sheets.

• Coordinate pay on approved workers' compensation cases with carrierandmaintainclaims in leave management system.Determineandestablishaccuratecoding of unpaid (FMLA, ADA, WC)and paid (STD, PPL, LTD) leavesinHRISsystem.

• Ensureaccurateapplication of state offsets,maintainoffset calculators,and continuouslymonitor forany changes in offset amounts or the inclusion of new states.

• Coordinate with 3rdparty vendor for claim administration and lost time for Canadian leaves.

• AssisttheNurse Case Managerin gathering all case materialstopreparean appeal before theWelfare PlanCommittee.

• As needed, work withHRlegal department in drafting employeedisability communications.

• CompleteannualLTD audit.

• Perform Iron Mountain File archiving.

• Provides training and support to Managers for any leaves related issue.

• Deliversongoing training to HR Support Lineagents.

• Troubleshoots andassistswith leave management system;collaborate on resolution plans.

• Create, audit, anddistribute reports as needed.

• Triageand addressnon-clinicalJira tickets.

• Managefax server documents/email inbox (Absence Management,Workers' Compensation, Fitness Center).

• Coordinateinvoices/bill payments.

• Manageandschedule all meetings. Draft and circulate meeting agendas and minutes.

• Respond to all department subpoenas and requests for Absence Management documentation.

• Complete all requests for disabilitypayinformation on state disability forms.

• Complete special projects, and travel, as assigned.This includes assisting with projects within the Benefits department.

Your Background

As aLeave Administrative Specialist, you have:

• 5+yearsclaims processing experiences within an insurance company or third-party administrator.

• Experience intightlymanaging claims and administering services on self-insured accounts.

• Problem-solving ability.

• Excellent written and verbal communication skills for both counseling and meeting presentations.

• Excellent interpersonal skills and the ability to deal with all levels of management and employees onvery sensitiveand emotional issues.

• Experience with good customer service standards.

• Candidates need todemonstrateinvestigative and analytical skills, advanced written and verbal skills, a proven record in return-to-workprograms,andunderstanding the social security disability insurance program.

• Ability to work effectively within a team atmosphere.

• Excellent computer skills.

• Knowledge of benefit administration and/or similar administrative skills.

• Complete understandingand application ofall current plans and practices.

• Ability to be completely objective and not easily swayed by the personal interest of unit administrators or individual employee claimants.

• Familiarity with STD, FMLA, LTD, WC, ADA,PPL, state offsets,OSHA & safety rules & guidelines.

Compensation:

The hourly wage range for this position is $32-$36 per hour. Actual compensation will be based on skills and experience as they relate to the job requirements and the location where you will be performing the job.

Location:

Employeesresidingwithin1hourdriving distance of Sheltonare required totravel to local office(s) as assigned, minimumfourdaysper week.Subject to change based onbusiness needs.

Sponsorship:

Must be legally authorized to work in the US.Employerwill not sponsorpositionfor employment visa status now or in the future (ex. H-1B).