PFML - FMLA Leave Claims Specialist

In this role, we specialize in the precise, timely, and comprehensive evaluation of Paid Family & Medical Leave, State Leave, and other absence-related programs. Our approach involves thorough analysis and determination of the appropriate action steps, all while strictly adhering to internal and external regulations. Committed to excellence, we ensure an industry-leading customer experience in every interaction.

Class Starts December 7th and training is 7 weeks

Hours for training are 7:30am-4:30pm cst time

WHAT WE CAN OFFER YOU:

• Estimated Hourly Wage (Levels have variable responsibilities and qualifications)
  • Leave Claim Specialist: $25.00 - $26.00 plus annual bonus opportunity.
  • Sr Leave Claim Specialist $27.00 – $29.00 plus annual bonus opportunity.
• 401(k) plan with a 2% company contribution and 6% company match.
• Work-life balance with vacation, personal time and paid holidays. See our benefits and perks page for details.
• Applicants for this position must not now, nor at any point in the future, require sponsorship for employment.

WHAT YOU'LL DO:

• Makes sound recommendations and works towards independent decision-making by thoroughly evaluating claims and gathering necessary information to formulate action plans.
• Develops files that demonstrate appropriate decision-making based on claim facts, policy provisions, state regulations, and customer expectations, ensuring all actions and rationales are well-documented.
• Establishes and maintains professional relationships with claimants, brokers, sales organizations, vendor partners, employers, and internal partners, ensuring communication aligns with Mutual of Omaha's values.
• Accurately determines financial liability based on various factors and manages claims with limited autonomy to approve payments, ensuring timely and accurate claims processing.
• Adheres to federal and state laws for group disability insurance, stays updated on industry changes, and consistently provides high-level customer service, including clear written explanations to claimants.

WHAT YOU’LL BRING:

• Develops understanding of complex insurance provisions and contracts, and applies insurance regulations to claim situations.
• Analyzes and interprets vocational and medical information for claims decisions, calculates benefits based on contract provisions, and demonstrates strong analytical and decision-making skills.
• Manages tasks efficiently using multiple systems, meets deadlines, and transitions from dependent to independent decision-making.
• Communicates professionally with high customer service standards, both written and verbal, and effectively diffuses situations and escalates when necessary.
• Proficient in personal computers, Microsoft applications, and Mutual of Omaha systems, with strong organizational skills, attention to detail, adaptability to change, and the ability to manage ongoing claims for multi-year durations.
• You promote a collaborative culture, value different ideas and opinions, and listen courageously, remaining curious in all that you do.
• Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico.

PREFERRED:

• Disability experience
• PFML, FMLA experience
• Leave Absence Management experience

We value unique experience, skills, and passion for innovation. If your experience aligns with the listed requirements, please apply!

If you have questions about your application or the hiring process, email our Talent Acquisition area at . Please allow at least one week from time of applying if you are checking on the status.

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Originally posted on Himalayas