STD & FMLA Claims Specialist — ET Shift

Media Riders Inc.; Jacksonville (FL); On-site; USD 52,000 - 76,000; Full time

Job summary

Media Riders Inc. is seeking a Short-Term Disability Claims Specialist to manage STD claims and FMLA leave for group benefits clients.

The role collaborates with employers, employees, healthcare providers, and HR partners to review claims, make benefit decisions, and coordinate leave and accommodations in compliance with laws. Responsibilities include reviewing claims for approval/denial, calculating payments within policy limits, applying duration guidelines, administering FMLA/STD,

Qualifications

• Associate or Bachelor's degree.
• 1-2 years of customer service, financial services, or claims experience.
• Knowledge of FMLA, ADA, short-term disability, or leave administration.
• Experience at an insurance carrier, third-party administrator (TPA), employer leave program, or healthcare organization.
• Ability to interpret medical and legal terminology and use legal resources.
• Strong mathematical skills for benefit calculations and payment adjustments.
• Strong organizational, communication, and time management skills.
• Experience managing a varied caseload and multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Outlook, Word, and Excel.

Responsibilities

• Review Short Term Disability claims and make final approval or denial decisions based on policy provisions.
• Calculate, approve, and adjust claim payments within established limits.
• Apply duration guidelines and clinical and vocational recommendations to determine benefit periods.
• Administer integrated FMLA leave and Short Term Disability claims, including routine and complex cases.
• Interpret contracts and apply federal and state laws, including FMLA, ADA, USERRA, the Pregnancy Discrimination Act, and state disability plans.
• Facilitate the ADA interactive process with employees, supervisors, medical providers, and HR business partners.
• Advise employers and employees on leave rights, responsibilities, and procedures.
• Obtain supporting documentation and communicate with claimants, employers, physicians, hospitals, and attorneys.
• Develop claim action plans and document all contacts, requests, and decisions.
• Protect health information in accordance with HIPAA and company privacy standards.
• Provide support to claims staff and assist with special projects as needed.

Skills

Customer service

Claims processing

Legal terminology

Time management

Communication

Education

Associate or Bachelor's degree

Tools

Microsoft Outlook

Microsoft Word

Microsoft Excel

Job description

Media Riders Inc. is seeking a Short-Term Disability Claims Specialist to manage STD claims and FMLA leave for group benefits clients.

The role collaborates with employers, employees, healthcare providers, and HR partners to review claims, make benefit decisions, and coordinate leave and accommodations in compliance with laws. Responsibilities include reviewing claims for approval/denial, calculating payments within policy limits, applying duration guidelines, administering FMLA/STD,