Integrated Absence Claims Specialist Jobs (NOW HIRING)

Work Schedule:
The first 7 weeks of training will take place onsite at The Vision (116 15th Street, Pittsburgh, PA 15222), Monday through Friday. After training, employees will be evaluated. Once they demonstrate proficiency, the role will transition to a hybrid schedule: Remote: Mondays and Fridays, and Onsite: Tuesday, Wednesday & Thursday. 

Role Overview:

As an Integrated Absence Manager, you will be assigned a caseload of concurrent cases (paid/unpaid leave and Short-Term disability plans) managing all aspects of an employee's absence. The Integrated Absence Manager will conduct thorough investigations, determine eligibility for our customers, provide ongoing Absence administration, and communicate decisions and status updates.  This role is responsible for collaborating with customers, health care providers and clients to ensure timely, accurate Absence administration and payments. Upon approval of Absences, you will provide ongoing Absence management services, assist with return-to-work needs, and communicate decisions and status updates with customers and clients both verbal and written.

The Integrated Absence Manager plays a critical role in executing the New York Life Group Benefit Solutions (GBS) promise to our customers and has a direct impact on our customers in the moments that matter.  The ability to work in a fast-paced and detail-oriented environment while integrating knowledge of medical conditions, customer contracts, New York Life GBS, and corporate compliance are critical for success.

What You'll Do:

• Responsible for managing a caseload of Absence cases including the management of Short-Term Disability (STD), Paid Family Medical Leave (PFML), Family Medical Leave Act (FMLA), Company Paid Leave (CPL), and Americans with Disability Act of 1990 (ADA) and providing service excellence to GBS customers.
• Own and review assigned cases.  This includes verifying eligibility, capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources. 
• Evaluate available information to make claim and leave determinations within compliance guidelines; pay all covered claims accurately and timely.
• Coordinate multiple leave and disability plans using integrated technology.
• Support ongoing claim management including extensions and reviewing of additional information as needed to support ongoing claim decisions.
• Effectively communicate with claimants, employers, and various medical professionals both verbally and in writing to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits and applicable leave plans.
• Respond to all telephonic and email inquiries within customer service protocols and adhere to standard timeframes for processing mail, tasks, and outliers.  Execute all customer performance guarantees as defined.
• Document clear absence notes in the system based on medical received or conversations with the customer, provider, and client.
• Proactively work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis.
• Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
• Execution of New York Life and Corporate Compliance, Policies and Procedures and best practices.
• Ongoing development via training associated with role and business unit objectives.

What You'll Bring:

• HS Diploma or GED required. Bachelor's degree strongly preferred.
• 2+ years' experience administering Disability strongly preferred.
• Experience administering FMLA and/or State Leaves experience strongly preferred.
• Proficiency with MS Office applications is required (Word, Outlook, Excel.)
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
• Strong critical thinking, analytical, and investigative skills; ability to gather information, analyze facts, and draw conclusions. 
• Ability to understand complex absence scenarios and apply them to work.
• Ability to work with a bias for action and be a self-starter with a customer-focus mindset.
• Effective interpersonal, written, and verbal communication skills including the ability to articulate complex claim scenarios and translate them to easily understandable for customers and clients.
• Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
• Attention to detail is critical to effectively handle the technical aspects of the job.
• Excellent planning, time management and organizational skills.  Ability to manage multiple and changing priorities.
• Strong critical thinking and analytical skills to effectively multi-task and prioritize work to meet tight deadlines.
• Strong negotiation skills.
• Must be able to work with urgency and be a self-starter with a customer focus mindset.
• Ability to build and maintain effective relationships.
• Knowledge of legal liability, insurance coverage and medical terminology is helpful.
• A proven track record of successfully driving results in a complex matrix environment is required.
• Ability to work well under pressure. 

It is recommended that all qualified candidates apply to this posting as soon as possible.  Residents of Colorado are hereby notified that the deadline to apply is 1 week from the Posting Date listed above.