Disability & FMLA Claims Specialist

Tata Consultancy Services; Charlotte (NC); On-site; USD 48,000 - 57,000; Full time

Benefits offered by this job

Discretionary Annual Incentive

Comprehensive Medical Coverage

Family Support

Commuter Benefits

Certification & Training Reimbursement

Vacation & Holidays

401K Plan

Job summary

Tata Consultancy Services is seeking a qualified Absence Case Manager to handle disability and FMLA/PFL claims adjudications. The role requires reviewing medical documentation, determining eligibility, and ensuring timely payments according to regulations.

You will interact with claimants and clients to set expectations and support continuous improvement. Responsibilities include case review, escalation handling, and collaborating with team leads to address key issues while leveraging MS Office

Qualifications

• 1+ year of Disability/FMLA/PFL claims or insurance claims experience.
• Experience working with FINEOS.
• Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices.
• 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 work environment.
• Identify escalated cases and work with Team Leader to develop a plan to address key issues.

Responsibilities

• Provide Absence case management and claim adjudications based on medical documentation and applicable disability/fmla/pfl interpretation.
• Review and analyze claim nuances, eligibility review, and type of claims (intermittent or continuous).
• Analyze medical information to determine if the claimant is disabled as defined.
• Approve or deny FMLA claims per insurance carrier and employer guidelines.
• Analyze and authorize assigned claims and determine benefits due under disability and family leave regulations.
• Review claims for Not in good order cases and secure missing documentation.

Skills

Disability claims experience

FMLA/PFL claims experience

FINEOS experience

Medical terminology knowledge

Communication skills

Analytical/problem solving

MS Office proficiency

Change management

Team collaboration

Education

Diploma

Tools

FINEOS

MS Office (Excel, Word, PPT)

Job description

Tata Consultancy Services is seeking a qualified Absence Case Manager to handle disability and FMLA/PFL claims adjudications. The role requires reviewing medical documentation, determining eligibility, and ensuring timely payments according to regulations.

You will interact with claimants and clients to set expectations and support continuous improvement. Responsibilities include case review, escalation handling, and collaborating with team leads to address key issues while leveraging MS Office