Absence & FMLA Claims Specialist

Tata Consultancy Services; Port Saint Lucie (FL); On-site; USD 48,000 - 57,000; Full time

Benefits offered by this job

Discretionary Annual Incentive

Medical Coverage

Dental & Vision

Disability Insurance

Pet Insurance

Commuter Benefits

Certification & Training Reimbursement

Vacation & Holidays

401K Plan

Performance Bonus

College Fund

Student Loan Refinancing

Job summary

Tata Consultancy Services in Port Saint Lucie, FL is seeking an experienced claims professional to manage absence cases and adjudicate Disability/FMLA/PFL claims based on medical documentation. You will review claims, determine benefits due, communicate with claimants, and ensure timely payments while complying with regulations.

A diploma and 1+ year of relevant claims experience required; strong MS Office skills and knowledge of medical terminology are expected.

Qualifications

• 1+ year of Disability/FMLA/PFL claims or insurance claims experience.
• Experience working with FINEOS.
• Working knowledge of medical terminology and documents (APS, tests, records).
• Knowledge of disability insurance claims, benefits administration, offsets and deductions, duration and medical management.
• Excellent oral and written communication, including presentation skills.
• Strong analytical, decision making, problem solving, and people management skills.
• Proficiency in MS Office (Excel, Word, PPT).
• Willingness to embrace change in a fast paced environment.
• Desire to continuously learn and improve.
• Identify escalated cases and work with Team Leader to address key issues.

Responsibilities

• Provide absence case management and claim adjudications per disability/FMLA/PFL guidelines.
• Review claim nuances, eligibility, and type of claims.
• Determine benefits due and ensure timely payments and adjustments.
• Review medical information to determine disability status.
• Approve or deny FMLA claims per carrier and employer guidelines.
• Communicate with claimants and clients to set expectations.
• Manage workload and second-level process escalation.
• Provide ideas to management on continuous improvement and service level management.
• Perform other duties or participate in special projects as assigned.

Skills

Communication

Analytical skills

Decision making

Problem solving

People management

Adaptability

Education

Diploma

Tools

FINEOS

MS Office

Job description

Tata Consultancy Services in Port Saint Lucie, FL is seeking an experienced claims professional to manage absence cases and adjudicate Disability/FMLA/PFL claims based on medical documentation. You will review claims, determine benefits due, communicate with claimants, and ensure timely payments while complying with regulations.

A diploma and 1+ year of relevant claims experience required; strong MS Office skills and knowledge of medical terminology are expected.