Disability & FMLA Claims Specialist

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

Benefits offered by this job

Medical Coverage

Dental & Vision

Parental Leaves

Commuter Benefits

Certification & Training

Time Off

Job summary

Tata Consultancy Services is seeking an experienced claims professional to provide Absence case management and adjudication for Disability/FMLA/Paid Family Leave, ensuring timely benefit payments and adjustments based on medical documentation.

The role involves reviewing medical records, determining disability, approving or denying FMLA claims, and coordinating with teams to manage benefits across various disability offsets. Strong communication and analytical skills are essential.

Qualifications

• 1+ year of Disability/FMLA/PFL claims or insurance claims experience.
• Experience with FINEOS.
• Working knowledge of medical terminology and documents, including APS, diagnostic tests, imaging reports.

Responsibilities

• Review and analyze claim nuances, eligibility review, and type of claims (intermittent or continuous).
• Review medical information to determine if the claimant is disabled as defined.
• Approve 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, secure missing documentation with outreach.
• Communicate with claimants and clients to set expectations on the claims process by phone or written correspondence.
• Review client deliverables, manage workload, and escalate as needed.
• Determine benefits due and make timely payments/adjustments for Workers’ Compensation, Short Term Disability, and other offsets.
• Refer cases to team lead and clinical case management.
• Manage day-to-day workload and escalation, and review processes for accuracy in peer reviews.
• Provide ideas to management on continuous improvement and service levels.
• Perform other duties or special projects as assigned.

Skills

Disability claims

FMLA/PFL

Medical terminology

Analytical skills

Communication skills

Education

Associateship

Tools

FINEOS

Job description

Tata Consultancy Services is seeking an experienced claims professional to provide Absence case management and adjudication for Disability/FMLA/Paid Family Leave, ensuring timely benefit payments and adjustments based on medical documentation.

The role involves reviewing medical records, determining disability, approving or denying FMLA claims, and coordinating with teams to manage benefits across various disability offsets. Strong communication and analytical skills are essential.