Ability Analyst Paid Family Medical Leave

The Hartford • Alpharetta, GA

3d • $48,071 - $76,267 • Hybrid

About The Position

This role requires strong analytical expertise, strategic thinking, and communication skills to accurately adjudicate PFML claims. As an Ability Analyst, you will play a critical role in supporting individuals during some of the most challenging times in their lives. You will be responsible for managing a caseload of PFML claims of moderate complexity, ensuring each claim is handled with empathy, accuracy, and efficiency. This role requires a balance of analytical thinking, customer service, and regulatory compliance. You will serve as the primary point of contact for claimants, employers, and medical professionals, guiding them through the claims process and ensuring timely and fair outcomes. Your work will directly impact the financial and emotional well-being of our customers.
Ability Specialist for the All Products team supports Paid Family and Medical Leave, Short Term Disability and Leave of Absence. This role requires strong analytical expertise, strategic thinking, and communication skills to accurately adjudicate claims. As Ability Specialist, you will play a critical role in supporting individuals during some of the most challenging times in their lives. You will be responsible for managing a caseload of Paid Family and Medical Leave, Short Term Disability and Leave of Absence claims of high complexity, ensuring each claim is handled with empathy, accuracy, and efficiency. This role requires a balance of analytical thinking, customer service, and regulatory compliance. You will serve as the primary point of contact for claimants, employers, and medical professionals, guiding them through the claims process and ensuring timely and fair outcomes. Your work will directly impact the financial and emotional well-being of our customers.

Requirements

• Bachelor’s degree or equivalent work experience in insurance claims adjudication, healthcare, or a related field preferred.
• THAA experience preferred.
• Ability to understand state regulations, compliance requirements, and medical terminology.
• Ability to recognize red flags and escalate high-risk or potentially fraudulent claims appropriately.
• Excellent analytical, organizational, and time management skills.
• Proven ability to multitask effectively in a fast-paced, deadline-driven environment.
• Demonstrated problem-solving skills with the ability to think critically, make sound decisions, and drive solutions.
• Strong interpersonal skills with a team-oriented mindset and ability to collaborate cross-functionally.
• Exceptional written and verbal communication skills.
• Proficiency in claims management systems.

Responsibilities

• Independently manage a caseload of PFML claims from intake through resolution.
• Conduct thorough reviews of medical records, employment history, and policy provisions.
• Determine eligibility and benefit entitlement based on contractual language and supporting documentation.
• Serve as the main contact for claimants, providing clear, compassionate, and timely updates.
• Communicate with employers, physicians, and legal representatives to gather and clarify information.
• Educate claimants on the PFML process, timelines, and expectations.
• Make well-reasoned decisions supported by evidence and aligned with policy terms.
• Document all claim activity, rationale, and communications in a clear and professional manner.
• Prepare written correspondence including approval, denial, and status letters.
• Collaborate with internal resources such as peers, CRO, SIU, and Team Leader.
• Escalate complex or high-risk claims to senior team members or management as appropriate.
• Ensure all claims are handled in compliance with state regulations, HIPAA, and other applicable requirements.
• Participate in audits, quality reviews, and continuous improvement initiatives.

Benefits

• 401K
• Medical, Dental, Vision, Life and Disability Insurance. Effective day 1.
• 25 days paid time off in your first full year
• Paid Holidays
• Tuition reimbursement - up to $5,250 (undergraduate) and $6,000 (graduate) for tuition and registration fees for degree programs that support your career development (subject to additional requirements).
• Student Loan Paydown Program – eligible to participate after 6 months of service. The Hartford will make a direct contribution of $125 per month – with a lifetime maximum up to $10,000 – as a supplemental payment towards your student loan in order to help you manage the stress of student debt and help you pay down your student loan faster.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree