Claims Specialist – Leave & Disability
Core
Guide claimants through leave and disability experiences with empathy, administering Short Term Disability, FMLA, and other leaves while ensuring regulatory compliance.
Role type
Claims Specialist (Leave & Disability)
Builds
End-to-end claim experiences for employees
Domain
Insurance / Human Resources / Benefits Administration
Deliverable
client delivery
Required skills
STD/FMLA claims management, medical documentation evaluation, policy interpretation, stakeholder relationship management, SLA management, Microsoft Office 365
Preferred skills
Clinical and vocational resource utilization, cross-functional collaboration
Responsibilities
Analyze FMLA and short-term disability benefits to determine eligibility; Evaluate medical documentation to ensure eligibility for benefits; Manage assigned work queues within defined service level agreements (SLAs); Communicate with medical providers to obtain necessary medical documentation; Document claim decisions and ongoing case management activities; Clearly explain claim decisions and entitled benefits to claimants.
