Integrated Claims Specialist - Leave of Absence/Disability - Alera Group

OVERVIEW

AbSolve Absence Solutions, an Alera Group Company is seeking an Integrated Claims Specialist - Leave of Absence/Disability to join our Mount Laurel team.

Absolve is a leading provider of absence and disability solutions for large employers. Our proprietary disability and claims management process provides employees with expert support during their leave. Rest assured that each employee's case will be managed consistently, in compliance with federal and state leave law. Our focus is creating healthier, more productive workforces by reducing the amount of time employees miss work due to unscheduled absences.

When leaves are unavoidable, our team takes care of them from beginning to end. It is our commitment to make employees out on leave feel supported and ensure that they get their benefits as quickly and easily as possible.

In a telephonic customer service environment, the Integrated Claims Specialist - Leave of Absence/Disability works as part of the claims team ensuring accurate and timely processing and payment of all FMLA, New York Paid Family Leave, as well as New York and New Jersey Short-term Disability claims while providing an exceptional customer experience from start to finish. Integrated Claims Specialist - Leave of Absence/Disability are the "first response" for employees in need and must demonstrate a caring, responsive, and problem-solving attitude at all times while assigned to our Customer Service telephone queue. They are responsible for understanding and correctly communicating Federal and State leave laws and disability policy benefits to Human Resource partners and claimants.

RESPONSIBILITIES

• Serves as the first point of contact for employees needing to initiate the disability claim and leave evaluation process
• Receives and triages incoming communications to determine nature of callers' request and which laws and insurance applications will apply
• Takes accurate and detailed statements from all involved parties; collects all pertinent information from employees and enters that information accurately into the claims system
• Verifies employee eligibility for coverage/benefits through a use of mixed resources and enters all pertinent information timely, completely, and accurately
• Assists employees in navigating the disability/leave of absence claim process
• Understands and respects the sensitivity and confidential nature of issues discussed and information handled
• Exercises careful discretion and complete HIPAA compliancy when collecting, discussing and documenting any/all customer information
• Sends acknowledgement and authorization correspondence within legally required timeframes
• Requests employee leave policy kits and any other necessary information from employers and third parties timely with consistent follow up through to claim completion
• Redirects quality of care/service complaints to Contact Center Manager only when absolutely necessary, using interpersonal skills to de-escalate negative conversation
• Ensures all incoming claims are processed in accordance with regulatory requirements and adheres to mandated compliance timeframes
• Responsible for handling mail, faxes and voice mail messages on a daily basis
• Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to applicable laws and policies as well as internal protocol and reporting requirements
• Calculates and approves payment of claims within a certain monetary limit with 100% accuracy
• Communicates claim action with claimant and client
• Ensures claim files are properly documented and claims coding is correct
• Coordinates with Management and senior staff in handling cases correctly
• Performs 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
• Must possess high levels of fiduciary responsibility, self-accountability, att