Title: Leave Case Administrator
Leave Administrator is responsible for reviewing, investigating and documenting Integrated Short Term Disability (STD), Statutory, Paid Family Leave and FMLA claims to determine eligibility for benefits.
Location: This position will work in an onsite model. Ideal candidates will live within 50 miles of one of our PulsePoint locations.
Primary duties may include, but are not limited to:
- Reviews claim materials against disability policy coverage and duration guidelines to determine liability and adjudicate the claim.
- Gathers clinical and eligibility information to verify the approved period of disability.
- Provides policyholder relationship management.
- Advises policyholders on coordination between Paid Family Leave, FMLA, and Statutory Benefits.
- Ensures compliance with all federal and state leave laws.
- Oversees coordination of ADA management within the FMLA/Disability claim.
- Works with Disability Case Management Nurses and Physician Reviewers to review complex/questionable claims.
- Maintains up-to-date knowledge of company products and services.
- Knowledge of ERISA, Fair Claims Practices Model Act, privacy regulations, punitive damages statutes, and state and federal laws governing group insurance.
- Administers disability income payments on behalf of group policyholders.
- Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
- Monitors and acts on potential benefit reductions under contract fraud, misrepresentation, and malingering.
- Provides testimony involved in depositions in contested claims.
- Administers payments on a monthly and weekly basis.
- Performs calculations and reviews adjustments for Social Security and Worker's Compensation awards.
- Mails appropriate State program forms to employees.
- Performs audits of STD/FMLA/PFL/DBL claims; provides coaching, mentoring, and feedback as directed by Manager.
- Manages LOA cases and interfaces with manager, associate, and HR.
- Partners with the HR team to review LOA data and improve LOA results.
- Counsels managers and HR Consultants on FMLA law and procedures as well as STD policy and procedures.
- HS diploma
- Onsite within 50 miles of a Pulse Point
- Minimum of 4 years experience in health and welfare benefits, disability management, HR operations, and/or benefits administration; or any combination of education and experience, which would provide an equivalent background.
- Certification in FMLA, ADA, and/or PFL
- BA/BS degree
For candidates working in person or remotely in the below locations, the salary* range for this specific position is $23.65/hr to $42.58/hr
Locations: California; Colorado; Nevada; Washington State; Jersey City, NJ; New York City, NY; Ithaca, NY and Westchester County, NY
In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .
* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.
For URAC - accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.