Senior Specialist – Integrated Absence & STD

Senior Specialist – Integrated Absence & STD

Requirements

• Ability to work in a self-directed manner in a team environment
• Exposure to various issues within disability and absence product lines
• Solid analytical, critical thinking, problem solving and decision-making skills
• Ability to interpret and communicate disability contract language and 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
• Strong interpersonal and customer service skills
• Ability to initiate and prioritize regular work duties and projects
• Detail oriented, organized, the ability to multi-task, and strong time management skills
• Strong computer skills, proficient in a PC environment and MS Word, Excel, and email systems
• Ability to work professionally and effectively with diverse co-workers, clients, claimants, vendors and others with whom DRMS does business
• High School Diploma or equivalent
• 1+ years of previous short-term disability and FMLA and/or PFL product line experience required

Responsibilities

• Reviews and investigates disability, FMLA, PFL, ADA and other leave claims thoroughly by using telephone and written contact with the applicable parties, (claimant, employer/supervisor, credit union, treating physician, etc.) to gather pertinent data to analyze the claim(s)
• Adjudicates claims accurately and fairly in accordance with federal, state, local, and ERISA regulations and the STD contract, appropriate claim policies and procedures, meeting productivity and quality standards
• Utilizes appropriate medical, vocational, and risk resources, adhering to referral polices, and transferring claims to the appropriate risk level in a timely manner
• Conducts in-depth pre-existing condition or contestable investigations if applicable
• Calculates benefit payments, which may include partial disability or PFL or other benefits, integration with other income sources, survivor benefits, residual disability benefits, cost of living adjustments, etc.
• Develops and maintains on-line claim data (and paper file if applicable)
• Documents and communicates claim decisions
• Sends timely appropriate notifications according to communication preferences of claimant and employer
• Coordinates return to work, working with vocational rehabilitation consultant as necessary
• Coordinates placement of needed accommodations for client employees and claimants, working with employer, health care provider, and vocational rehabilitation consultant as needed
• Acts with a sense of urgency in responding to customer inquiries
• Obtains/maintains TPA licensing and required credit hours
• Participates in in-service and training opportunities as required
• Assists with desk coverage and supports peer as available
• Contributes to the development of internal policies and procedures
• Participates in industry or client meetings
• Other duties and responsibilities as needed

Preferred Qualifications

No preferred qualifications provided.