Integrated Leave Specialist

3 weeks ago


Laurel, Montana, United States Alera Group, Inc. Full time

Job Summary

Absolve Absence Solutions, an Alera Group Company, is seeking an Integrated Leave Specialist to join our team. As a key member of our claims team, you will be responsible for ensuring accurate and timely processing and payment of all FMLA, New York Paid Family Leave, and New York and New Jersey Short-term Disability claims while providing an exceptional customer experience.

Key Responsibilities

  • Serve as the first point of contact for employees needing to initiate the disability claim and leave evaluation process.
  • Receive and triage incoming communications to determine the nature of the caller's request and which laws and insurance applications will apply.
  • Take accurate and detailed statements from all involved parties and collect all pertinent information from employees and enter that information accurately into the claims system.
  • Verify employee eligibility for coverage/benefits through a use of mixed resources and enter all pertinent information timely, completely, and accurately.
  • Assist employees in navigating the disability/leave of absence claim process.
  • Understand and respect the sensitivity and confidential nature of issues discussed and information handled.
  • Exercise careful discretion and complete HIPAA compliance when collecting, discussing, and documenting any/all customer information.
  • Send acknowledgement and authorization correspondence within legally required timeframes.
  • Request employee leave policy kits and any other necessary information from employers and third parties timely with consistent follow-up through to claim completion.
  • Redirect quality of care/service complaints to the Contact Center Manager only when absolutely necessary, using interpersonal skills to de-escalate negative conversations.
  • Ensure all incoming claims are processed in accordance with regulatory requirements and adhere to mandated compliance timeframes.
  • Responsible for handling mail, faxes, and voice mail messages on a daily basis.
  • Approve and process assigned claims, determine benefits due, and manage action plans pursuant to applicable laws and policies as well as internal protocol and reporting requirements.
  • Calculate and approve payment of claims within a certain monetary limit with 100% accuracy.
  • Communicate claim actions with claimants and clients.
  • Ensure claim files are properly documented and claims coding is correct.
  • Coordinate with Management and senior staff in handling cases correctly.
  • Perform other duties as assigned.

Qualifications

  • College degree from an accredited college and/or a minimum of three years general business or customer service experience is preferred in an insurance setting. This prior experience should demonstrate solid organization, communication, negotiation, and decision-making skills.
  • Requires excellent investigative, analytical, and multi-tasking abilities in a fast-paced environment.
  • Ability to maintain scheduled deadlines and work well with others as part of a cohesive team of caring individuals.
  • Must exhibit strong skills in technology to include keyboarding and familiarity with word processing software, electronic communications, and Internet research capabilities.
  • Excellent written and verbal communication skills.

Equal Opportunity Employment

Absolve Absence Solutions is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. We offer comprehensive benefits to employees, including medical, dental, STD, LTD, and life insurance, 401(k), paid time off, and much more.



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