Responsible for reviewing, investigating and documenting Integrated Short Term Disability (STD), Statutory, Paid Family Leave and FMLA claims to determine eligibility for benefits.
How you will make an impact:
- Reviews claim materials against disability policy coverage and duration guidelines to determine liability and adjudicates the claim.
- Gathers clinical and eligibility information to verify approved period of disability.
- Provides policyholder relationship management.
- Advises policyholders on coordination between Paid Family Leave, FMLA, 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 statues 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 Workers 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 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.
- 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.
Preferred Skills, Capabilities, and Experiences:
- Certification in FMLA, ADA, and/or PFL desired.
- BA/BS degree.
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.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
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.