Job Responsibilities

Basic Function:

• Administer ADA (Americans with Disability Act) standalone claims
• Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems
• Promptly review new ADA, evaluate against appropriate leave plans and make initial claim decision
• Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc.
• Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
• Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
• The position is expected to do absence management and adjudication on Federal, State and company leaves
• Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician's office

Essential Functions:

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
• Analyze and research all discrepancies
• Research & Investigate and resolve outstanding items
• Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
• Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
• Establish action plans for each file to bring claims to resolution
• Utilize internal and external specialty resources to maximize impact on each claim file
• Use PC programs to increase productivity and performance
• Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
• Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
• Work as a team member to meet office goals to obtain disability's vision while demonstrating core values and meeting key measures
• Ensure adherence to established attendance schedules
• Close visual activity - viewing a computer terminal and extensive reading

Education, Technical Skills & Other Critical Requirements

Education:

• Bachelor's degree (Any Stream) or diploma with a minimum of 15 years of education

Experience:

• Minimum 3-4 years of experience in customer service background of a transactional, blended process of insurance or related industry with relevant experience of working in a business environment (preferred but not compulsory)

Technical Skills:

• Good computer navigation skills
• Good keyboarding speed
• Good knowledge of complete MS Office suite

Process Specific Skills:

• Knowledge about the Insurance industry in US
• Knowledge about US Culture
• Knowledge of Insurance principles

Soft Skills (Mandatory/Desired):

• Communication skills – Consultative including excellent customer service, should be able to read, interpret business documents
• Good verbal/written communication
• Good with negotiation, probing and problem solving
• Proficiency in English – Active listening, Spoken and Written
• Analytical and interpersonal skills
• Escalate issues if required
• Data gathering ability/Eye for detail
• Team work/Managing Self/Adaptability
• Ability to work successfully in production driven environment
• Adaptability to change
• Ability to work on routine/standardized transactions
• Self disciplined and result oriented
• Ability to multi task
• Ability to work effectively as part of a team
• Knowledge of Medical Terminology (preferred but not compulsory)

Preferred:

• Claims, specifically disability, preferred
• Working knowledge of ADA/Disability/Leave procedures preferred
• Knowledge of system applications preferred

Complexity: Specialized/Technical skill set with domain expertise; excellent communication, strong customer service (probing, negotiation & problem solving) and ability to coordinate with multiple stakeholders consulting skills