Disability & FMLA Claims Specialist

Tata Consultancy Services; Winter Park (FL); On-site; USD 48,000 - 55,000; Full time

Benefits offered by this job

Annual incentive

Medical coverage

Family leaves

Insurance options

Commuter benefits

Training reimbursement

Vacation & time off

Legal & financial assistance

Job summary

Tata Consultancy Services in the United States is seeking an Absence/Disability claims specialist to manage FMLA/Paid Family Leave, review medical documentation, determine benefits due and ensure timely payments. Collaboration with claimants and clients is essential, with adherence to regulatory guidelines.

You will analyze claims, approve/deny FMLA cases, and escalate issues as needed while maintaining service levels and process improvements.

Qualifications

• 1+ year of Disability/FMLA/PFL claims or insurance claims experience.
• Experience working with FINEOS.
• Working knowledge of medical terminology and documents (APS, diagnostic tests, imaging reports).
• Knowledge of disability insurance claims, benefits administration, offsets and deductions.
• Excellent oral and written communication, including presentation skills.
• Strong analytical, decision making, problem solving, and people management skills.
• MS Office proficiency (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.

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.
• Review claims for Not in good order and secure missing documentation.
• Communicate with claimants and clients to set expectations on the claims process.
• Review client deliverables, manage workload, and escalate as needed.
• Determine benefits due and make timely payments/adjustments for various disabilities.
• Refer cases to team lead and clinical case management as appropriate.
• Manage day-to-day workload and first-level process escalation.
• Provide ideas for continuous improvement and SLA management.
• Perform other duties or participate in special projects.

Skills

Disability claims

FMLA/PFL

Medical terminology

Disability insurance

Communication skills

Analytical thinking

Case escalation

Change readiness

Continuous learning

Education

Associateship

Tools

FINEOS

MS Office

Job description

Tata Consultancy Services in the United States is seeking an Absence/Disability claims specialist to manage FMLA/Paid Family Leave, review medical documentation, determine benefits due and ensure timely payments. Collaboration with claimants and clients is essential, with adherence to regulatory guidelines.

You will analyze claims, approve/deny FMLA cases, and escalate issues as needed while maintaining service levels and process improvements.