Claims Consultant

Tata Consultancy Services; Mount Vernon (TX); On-site; USD 48,000 - 55,000; Full time

Benefits offered by this job

Discretionary Annual Incentive

Comprehensive Medical Coverage

Family Support

Convenience & Professional Growth

Time Off

Legal & Financial Assistance

Job summary

Tata Consultancy Services is hiring for a role focusing on Absence case management and claim adjudications in Mount Vernon, Texas. The position requires an individual with a strong background in Disability/FMLA/PFL claims.

Key responsibilities include reviewing medical claims, communicating with clients, and ensuring compliance with applicable laws. Ideal candidates will possess excellent communication and analytical skills, computer proficiency, and a desire to improve processes.

Qualifications

• 1+ year of experience in Disability/FMLA/PFL claims or insurance claims.
• Experience working with FINEOS software is a plus.
• Strong knowledge of medical documentation and terminology.

Responsibilities

• Provide Absence case management and claim adjudications.
• Review and analyze eligibility for claims.
• Determine benefits due and make timely payments.
• Communicate clearly with claimants and clients.
• Manage day-to-day workload and first-level process escalations.

Skills

Disability/FMLA/PFL claims experience

FINEOS software experience

Medical terminology knowledge

Analytical and problem-solving skills

Communication skills

MS Office proficiency

Education

Associateship

Job description

Overview

To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.

Responsibilities

• To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
• Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous).
• Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
• Approval or denial on FMLA claims as per Insurance carrier, and employer’s guidelines.
• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
• Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
• Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
• Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
• Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
• Refers cases as appropriate to team lead and clinical case management.
• Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
• Provide ideas to management on continuous improvement and service level management.
• Performs other duties or participates in special projects as assigned.

Requirements

• 1+ year of Disability/FMLA/PFL claims or insurance claims experience
• Experience working with FINEOS
• Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
• Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
• Excellent oral and written communication, including presentation skills
• Strong Analytical, decision making, problem solving, and people management skills
• Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
• Willingness to embrace change in a fast paced work environment
• A strong desire to continuously learn and improve
• Identify escalated cases and work with Team Leader to develop a plan to address key issues.

Benefits

• Discretionary Annual Incentive.
• Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
• Family Support: Maternal & Parental Leaves.
• Insurance Options: Auto & Home Insurance, Identity Theft Protection.
• Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement.
• Time Off: Vacation, Time Off, Sick Leave & Holidays.
• Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.

Salary Range: $48,000 - $55,000 per year

Qualifications: ASSOCIATESHIP