Absence & Disability Case Specialist

Equiliem; Wellesley (MA); Remote; USD 62,000 - 70,000; Full time

Benefits offered by this job

Medical Insurance

Vision & Dental Insurance

Life Insurance

Matching 401(k)

Commuter Benefits

Employee Discounts & Rewards

Payroll Payment Options

Job summary

Equiliem is seeking an Absence & Disability Case Specialist to administer leave and short-term disability cases for employees across the United States. The role focuses on compliant determinations, claim reviews, and coordination with healthcare providers and HR partners.

The position emphasizes independent work within a fast-paced environment, requiring attention to detail, sound judgment, and strong communication skills.

Qualifications

• 1-2 years of customer service or financial services experience.
• Experience with claims, absence management, disability management, healthcare, insurance, or carrier operations is preferred.
• Ability to understand and interpret legal and medical terminology and apply that information when evaluating claims.
• Strong mathematical skills for claim payment calculations and adjustments.
• Strong research, analytical, critical thinking, problem-solving, and decision-making skills.

Responsibilities

• Administer leave programs and policies in accordance with applicable federal and state laws, including FMLA, ADA, USERRA, and the Pregnancy Discrimination Act.
• Manage routine and complex short-term disability claims and make appropriate determinations regarding claim approval, denial, or further investigation.
• Review claim payments and medical recommendations to determine the appropriate disposition of claims.
• Establish and manage claim action plans to ensure timely, accurate, and efficient case resolution.
• Facilitate interactive discussions with employees, healthcare providers, supervisors, and HR partners regarding leave and accommodation requests.
• Document absence requests, accommodation activities, communications, and actions taken throughout the case lifecycle.
• Interpret applicable contracts, policies, and procedures and ensure consistent and compliant claims practices.
• Obtain medical and supporting documentation required to substantiate claims or absence requests.
• Communicate with employees, employers, healthcare providers, attorneys, vendors, and other stakeholders by telephone and other appropriate channels.
• Maintain confidentiality of protected health information and handle sensitive employee information in accordance with applicable privacy requirements.
• Provide technical assistance to other claims staff and participate in special projects as assigned.
• Work independently while collaborating effectively with internal teams and business partners.

Skills

Customer service

Claims processing

Legal terminology

Analytical thinking

Communication

Education

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Job description

Absence & Disability Case Specialist

Location: Remote - U.S.
Schedule/Shift: Monday-Friday, 8:30 AM-5:00 PM EST
Pay: $30.50 per hour

Position Overview

The Absence & Disability Case Specialist administers employee leave and short-term disability cases while ensuring compliance with applicable federal and state employment laws. This role works with employees, employers, healthcare providers, HR partners, and other stakeholders to evaluate absence requests, coordinate accommodations, review disability claims, and make timely benefit determinations. The position requires strong knowledge of absence and disability management, excellent judgment, attention to detail, and the ability to manage routine and complex cases independently in a fast-paced environment.

Job Responsibilities

• Administer leave programs and policies in accordance with applicable federal and state laws, including FMLA, ADA, USERRA, and the Pregnancy Discrimination Act.
• Manage routine and complex short-term disability claims and make appropriate determinations regarding claim approval, denial, or further investigation.
• Review claim payments and medical recommendations to determine the appropriate disposition of claims.
• Establish and manage claim action plans to ensure timely, accurate, and efficient case resolution.
• Facilitate interactive discussions with employees, healthcare providers, supervisors, and HR partners regarding leave and accommodation requests.
• Document absence requests, accommodation activities, communications, and actions taken throughout the case lifecycle.
• Interpret applicable contracts, policies, and procedures and ensure consistent and compliant claims practices.
• Obtain medical and supporting documentation required to substantiate claims or absence requests.
• Communicate with employees, employers, healthcare providers, attorneys, vendors, and other stakeholders by telephone and other appropriate channels.
• Maintain confidentiality of protected health information and handle sensitive employee information in accordance with applicable privacy requirements.
• Provide technical assistance to other claims staff and participate in special projects as assigned.
• Work independently while collaborating effectively with internal teams and business partners.

Job Requirements

• 1-2 years of customer service or financial services experience.
• Experience with claims, absence management, disability management, healthcare, insurance, third-party administration, employer leave administration, or carrier operations is preferred.
• Ability to understand and interpret legal and medical terminology and apply that information when evaluating claims.
• Strong mathematical skills for claim payment calculations and adjustments.
• Strong research, analytical, critical thinking, problem-solving, and decision-making skills.
• Strong computer skills, including proficiency with Microsoft Word, Excel, email, and standard business applications.
• Excellent verbal and written communication skills.
• Strong customer service and interpersonal skills.
• Strong organizational and time-management skills with the ability to prioritize and manage multiple cases and projects.
• Ability to work independently, exercise sound judgment, and make appropriate decisions.
• Strong facilitation skills and ability to communicate effectively with diverse stakeholders.
• Ability to work effectively in a fast-paced, service-oriented environment.
• Strong attention to detail and accuracy in documentation, reporting, and communication.
• Ability to handle confidential information professionally and appropriately.
• Ability to work effectively with employees, clients, claimants, vendors, healthcare providers, and internal business partners.

Education

• Bachelor's degree preferred but not required.

Work Experience

• 1-2 years of customer service or financial services experience required.
• Claims, medical terminology, absence management, disability management, healthcare, insurance, TPA, employer leave administration, or carrier experience preferred.

About Equiliem

Equiliem believes in empowering success. It's our job to cultivate relationships that connect people and employers in a way that is inclusive, intelligent, and allows both to thrive.

Across the U.S., leading companies in healthcare, government, engineering, manufacturing, professional services, and energy rely on us for their workforce solutions. Our recruiting and HR services include contract and direct hire staffing, Payrolling/EOR, Independent Contractor Compliance, and Managed Services.

For almost 30 years, we've helped shape our industry. Today, we continue to research, ask questions, and continuously enhance the candidate journey and client experience.

Benefits

We offer a comprehensive benefits package to our employees, which includes:

• Medical Insurance
• Vision & Dental Insurance
• Life Insurance
• Matching 401(k)
• Commuter Benefits
• Employee Discounts & Rewards
• Payroll Payment Options

EEO Employer

Equiliem is an equal opportunity employer. We do not discriminate or allow discrimination based on race, color, religion, creed, sex, age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Equiliem will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [emailprotected] or [phone].