Remote Absence & Disability Claims Specialist

Equiliem; Wellesley (MA); Remote; USD 62,000 - 70,000; Full time

Benefits offered by this job

Medical Insurance

Vision & Dental Insurance

Life Insurance

Matching 401(k)

Commuter Benefits

Employee Discounts & Rewards

Payroll Payment Options

Job summary

Equiliem is seeking an Absence & Disability Case Specialist to administer leave and short-term disability cases for employees across the United States. The role focuses on compliant determinations, claim reviews, and coordination with healthcare providers and HR partners.

The position emphasizes independent work within a fast-paced environment, requiring attention to detail, sound judgment, and strong communication skills.

Qualifications

• 1-2 years of customer service or financial services experience.
• Experience with claims, absence management, disability management, healthcare, insurance, or carrier operations is preferred.
• Ability to understand and interpret legal and medical terminology and apply that information when evaluating claims.
• Strong mathematical skills for claim payment calculations and adjustments.
• Strong research, analytical, critical thinking, problem-solving, and decision-making skills.

Responsibilities

• Administer leave programs and policies in accordance with applicable federal and state laws, including FMLA, ADA, USERRA, and the Pregnancy Discrimination Act.
• Manage routine and complex short-term disability claims and make appropriate determinations regarding claim approval, denial, or further investigation.
• Review claim payments and medical recommendations to determine the appropriate disposition of claims.
• Establish and manage claim action plans to ensure timely, accurate, and efficient case resolution.
• Facilitate interactive discussions with employees, healthcare providers, supervisors, and HR partners regarding leave and accommodation requests.
• Document absence requests, accommodation activities, communications, and actions taken throughout the case lifecycle.
• Interpret applicable contracts, policies, and procedures and ensure consistent and compliant claims practices.
• Obtain medical and supporting documentation required to substantiate claims or absence requests.
• Communicate with employees, employers, healthcare providers, attorneys, vendors, and other stakeholders by telephone and other appropriate channels.
• Maintain confidentiality of protected health information and handle sensitive employee information in accordance with applicable privacy requirements.
• Provide technical assistance to other claims staff and participate in special projects as assigned.
• Work independently while collaborating effectively with internal teams and business partners.

Skills

Customer service

Claims processing

Legal terminology

Analytical thinking

Communication

Education

Bachelor's degree preferred

Tools

Microsoft Excel

Microsoft Word

Job description

Equiliem is seeking an Absence & Disability Case Specialist to administer leave and short-term disability cases for employees across the United States. The role focuses on compliant determinations, claim reviews, and coordination with healthcare providers and HR partners.

The position emphasizes independent work within a fast-paced environment, requiring attention to detail, sound judgment, and strong communication skills.