Job Description
Remote Claims Specialist
Pay: $27.75/hour
The remote Claims Specialist acts under the general supervision of a Senior Manager managing a caseload of FMLA, Paid Family Leave (PFL), ADA, and other leave program claims.
- What you will do:
- Review and investigate Family Medical Leave Act (FMLA), Paid Family Leave (PFL), Americans with Disabilities Act (ADA), and other leave claims, by using telephone and written contact with the applicable parties (claimant, employer/supervisor, treating physician, etc.) to gather pertinent data to analyze the claim
- Adjudicate claims accurately and fairly in accordance with federal/state/local regulations, appropriate policies and procedures, meeting absence productivity and quality standards
- Utilize appropriate medical and vocational or other resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner
- Develop and maintain online claim data
- Document and communicate claim decisions
- Send timely, appropriate notifications according to the communication preferences of the claimant and employer
- Coordinate return to work, working with vocational rehabilitation consultant as necessary
- Coordinate placement of needed accommodations for client employees and claimants, working with employer, health care provider, and vocational rehabilitation consultant as needed
- Effectively adapts to change within the organization, department, and industry
- Participate in in-service and training opportunities as required
- What you will need to succeed:
- Exposure to various issues within FMLA and/or PFL with demonstrated experience in generating and selecting solutions to resolve those issues
- Solid analytical, critical thinking, problem-solving and decision-making skills
- Ability to interpret and communicate FMLA/PFL/ADA and other leave regulation language
- Excellent verbal communication skills, with the ability to be both pleasant and professional
- Strong written communication skills
- Solid mathematical skills
- Ability to work well independently and in a team environment
- Strong interpersonal and customer service skills
- Ability to initiate and prioritize regular work duties and projects
- Detail oriented, organized, the ability to multi-task
- Strong time management skills
- Strong computer skills, proficiency in a PC environment and MS Word, Excel, and email systems
- Ability to work professionally and effectively with a diverse range of people: co-workers, clients, claimants, vendors and others
- Required Education and Skills:
- High School degree or equivalent
- Minimum of 1 year experience with FMLA and/or PFL Claims
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