IntegratedADMSpecialist

TELUS Health (Canada); Chicago (IL); On-site; USD 80,000 - 110,000; Full time

Job summary

TELUS Health is seeking an experienced Integrated ADM Specialist to lead the ADA interactive process and PWFA compliance, manage FMLA and STD claims, and ensure accurate leave adjudication for the American operations.

You will guide employees through reasonable accommodation, coordinate with HR and clinicians, and monitor regulatory timelines to minimize risk while supporting timely return-to-work.

Qualifications

• Minimum 5+ years of direct experience managing Leaves, STD and ADA / PWFA claims, or high-level disability case management.
• Computer skills and the ability to work primarily online in a paperless environment.
• Strong interpersonal and helping skills along with assessment and problem-solving skills.
• Regulatory Expertise: Deep understanding of the Americans with Disabilities Act (ADA), Pregnancy Workers Fairness Act (PWFA), FMLA, and state-specific leave laws.
• Company policies and plans: experience in managing self-insured Short Term Disability (STD) Plans as well as company-specific paid and unpaid leave policies.
• Medical Literacy: Ability to review and interpret medical documentation and translate clinical restrictions.

Responsibilities

• Manage and process FMLA (and other Federal leaves as applicable) Military leaves, State leaves, company specific and STD claims.
• Manage all ADA and PWFA claims by advising clients on options for reasonable accommodation.
• Conduct case assessments, contacting the employee and HR to explain the leave management process.
• Develop and document an understanding of the situation and factors supporting return-to-work.
• Review all relevant information and consult with medical resources to confirm decisions.
• Determine an appropriate RTW goal with the employee and employer; provide active support for planning.
• Act as the primary case contact and communicate with employer representatives as needed.
• Follow all processes in SOPs and trainings; attend team meetings and trainings.
• Other projects and tasks as assigned.

Skills

Leaves management

ADA/PWFA expertise

FMLA knowledge

Job description

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

Responsibilities:

Our team and what we'll accomplish together The Integrated ADM Specialist serves as the primary subject matter expert and facilitator for the Americans with Disabilities Act (ADA) interactive process as well as the Pregnancy Workers Fairness Act (PWFA) in addition to overseeing, managing, processing, and adjudicating FMLA, State, and company specific leaves, as well as straightforward and complex STD claims; to determine benefits due pursuant to an STD plan: and to ensure the ongoing processing of claims.

Must analyze reported Family Medical Leave (FMLA) requests; to make determinations based on Federal and State regulations; to communicate clearly with clients and claimants on all aspects of the claims process; and to ensure that claim management processes are followed per our best practices and client specific steps.

With respect to the ADA and PWFA, this role is responsible for guiding employees and clients through the reasonable accommodation process, mitigating legal risk, and ensuring a seamless integration between short-term disability (STD), FMLA/leaves, and ADA requirements

What you'll do

Manage and process FMLA (and other Federal leaves as applicable) Military leaves, State leaves, company specific and STD claims. With regard to FMLA, will manage all DOL category claims; including re-certifications and the 2nd and 3rd opinion processes.

Manage all ADA and PWFA claims by advising clients on options for reasonable accommodation and making recommendations regarding the best approach for managing such claims as it relates to the ADA and PWFA.

Conduct case assessments, contacting the employee and their manager / HR by telephone or email, to explain the leave management process, employee accountabilities, and gather information for assessment purposes.

Develop and document an understanding of the situation and the factors supporting, as well as inhibiting, a successful return to work for the employee against the essential job functions and undue hardships for the client organization.

Review all relevant information and consult with appropriate medical resources as required (nurse consultants, health professionals, supervisory team) to confirm decision and recommendations on FMLA, State, Company specific leaves, STD and ADA cases.

Analyzes FMLA medical certifications and other medical documentation and ensures claim determination adheres to the required regulatory compliance timeframes.

Informs STD claimants of any documentation needed to process a claim, timeframe requirements, claim's status (e.g. STD approvals, denials, and consults), or any other information necessary to manage a claim.

Determine an appropriate RTW goal with the employee and the employer; as well as, provide active support for the return-to work planning process between the employee and their supervisor and intervene when necessary.

Act as the primary case contact and will communicate proactively and continuously with the employer's representative(s) regarding any case management matters that may be required through the life of claim.

Will follow all processes as laid out in the operating procedures and/or as detailed in trainings/meetings.

Attend Case Management and Disability Management department team meetings and trainings as required.

Other projects and tasks as assigned.

What you bring

Minimum 5+ years of direct experience managing Leaves, STD and ADA / PWFA claims or high-level disability case management.

Computer skills and the ability to work primarily online in a paperless environment.

Strong interpersonal and helping skills along with assessment and problem-solving skills.

Regulatory Expertise : Deep understanding of the Americans with Disabilities Act (ADA), Pregnancy Workers Fairness Act (PWFA), FMLA, and state-specific leave laws.

Company policies and plans: experiencing in managing self insured Short Term Disability (STD) Plans as well as company specific paid and unpaid leave policies.

Medical Literacy: Ability to review and interpret medical documentation and translate clinical restrictions aga