NEWPosted 2 hours ago

Job ID: JOB_ID_8474

Job Description:

This role involves managing absence case management and claim adjudications based on medical documentation and applicable FMLA/Paid Family Leave interpretations. The primary goal is to determine benefits due and ensure timely payments and adjustments.

Key Responsibilities:

  • Provide Absence case management and claim adjudications based on medical documentation and applicable FMLA/Paid Family Leave interpretation.
  • Determine benefits due and make timely payments and adjustments.
  • Review and analyze claim nuances, eligibility, and claim types (intermittent or continuous).
  • Analyze medical information (attending physician reports, medical records, diagnostic tests, office notes, operative reports) to determine disability as defined.
  • Approve or deny FMLA claims as per Insurance carrier and employers guidelines.
  • Analyze, approve, and authorize assigned claims and determine benefits due pursuant to US paid family law regulations.
  • Review claims for ‘Not in good order’ cases and work on securing missing documentation, including employee, physician, or employer outreach.
  • Communicate clearly with claimants and clients to set expectations on all aspects of the claims process via phone and/or written correspondence.
  • Review client critical deliverables, manage overall workload, and handle first-level process escalation.
  • Determine benefits due, make timely claims payments, approvals, and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
  • Refer cases as appropriate to team lead and clinical case management.
  • Manage day-to-day workload and first-level process escalation.
  • Review processes for accuracy and timeliness, especially in case of peer reviews.
  • Provide ideas to management on continuous improvement and service level management.
  • Perform other duties or participate in special projects as assigned.

Essential Skills:

  • Leave Claims Management
  • Understanding of FMLA and Paid Family Leave regulations.
  • Ability to analyze medical documentation and records.
  • Strong communication and interpersonal skills.
  • Proficiency in claim adjudication and benefit determination.
  • Experience with Workers Compensation and State Short Term Disability claims is a plus.

Compensation & Location

Salary: $60,000 – $90,000 per year (Estimated)

Location: Tampa, FL

Recruiter / Company – Contact Information

Email: lik@savi-tech.com

Interested in this position?
Apply via Email

Recruiter Notice:
To remove this job posting, please send an email from
lik@savi-tech.com with the subject:

DELETE_JOB_ID_8474

to delete@join-this.com.