Claims Consultant

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

Benefits offered by this job

Discretionary Annual Incentive.

Comprehensive Medical Coverage:Medical

Dental & Vision Coverage

401K Plan

Certification & Training Reimbursement

Vacation, Sick Leave & Holidays

Job summary

Tata Consultancy Services Limited in Port St. Lucie, FL is seeking an Absence and claims specialist to manage FMLA/PFL, review medical documentation, and adjudicate benefits.

You will determine eligibility, approve or deny claims, and ensure timely payments in line with US regulations. Responsibilities include analyzing claim nuances, securing missing documentation, communicating with claimants, and escalating complex cases.

Qualifications

• Excellent oral and written communication
• Strong analytical, decision making and problem solving skills
• Knowledge of disability insurance claims and benefits administration
• Experience with FMLA/PFL claims workflows
• FINEOS system experience preferred
• MS Office proficiency (Excel, Word, PPT)

Responsibilities

• Provide Absence case management and claim adjudications based on medical documentation
• Review and analyze claim nuances, eligibility and type of claims
• Review medical information to determine disability status
• Approve or deny FMLA claims per carrier and employer guidelines
• Analyze and authorize benefits due per regulations
• Identify missing documentation and facilitate outreach
• Communicate clearly with claimants and clients about the process
• Manage workload and escalate complex cases as needed
• Determine benefits due and ensure timely payments/adjustments
• Refer cases to team lead or clinical case management as needed
• Contribute ideas for continuous improvement and service levels

Skills

Communication skills

Analytical skills

Decision making

Problem solving

People management

Disability/FMLA claims experience

Medical terminology

Disability insurance knowledge

Tools

FINEOS

MS Office

Job description

sick time, short term disability, 401(k)

United States, Florida, Port St. Lucie

Oct 28, 2026

Job Description

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.

TCS Employee Benefits Summary

• 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 - $57,000 per year