Disability Claims Specialist - FMLA/PFL Expert

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

Benefits offered by this job

Annual incentive

Comprehensive medical coverage

Family support leaves

Insurance options

Training reimbursement

Vacation and holidays

401K plan

Job summary

Tata Consultancy Services is seeking aClaims Specialist in the US to handle absence case management and claim adjudications based on medical documentation and FMLA/Paid Family Leave rules. You will determine benefits due, approve or deny claims, and ensure timely payments and adjustments.

Responsibilities include reviewing medical information, communicating with claimants, managing workload, and escalating issues for process improvement. Associateship and FINEOS experience are preferred.

Qualifications

• 1+ year of disability/fmla/pfl claims or insurance claims experience.
• Working knowledge of medical terminology and documents (APS, diagnostic tests, imaging).
• Knowledge of disability insurance claims, benefits administration, offsets and deductions, and medical management.
• Excellent written and verbal communication skills.
• Proficiency with MS Office (Excel, Word, PPT).

Responsibilities

• Review and analyze claim nuances, eligibility review, and type of claims (intermittent or continuous).
• Review and analyze medical information to determine if the claimant is disabled as defined.
• Approval or denial on FMLA claims as per Insurance carrier and employer’s 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 the claimants and clients to set expectations on all aspects of the claims process
• Review client critical deliverables, manage the overall workload, and second-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, and review processes for accuracy and timeliness where applicable 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.

Skills

Disability/FMLA/PFL claims

Medical terminology

Oral and written communication

MS Office

Education

Associateship

Tools

FINEOS

Job description

Tata Consultancy Services is seeking aClaims Specialist in the US to handle absence case management and claim adjudications based on medical documentation and FMLA/Paid Family Leave rules. You will determine benefits due, approve or deny claims, and ensure timely payments and adjustments.

Responsibilities include reviewing medical information, communicating with claimants, managing workload, and escalating issues for process improvement. Associateship and FINEOS experience are preferred.