Absence Management Specialist

UPMC

2d•Remote

About The Position

The Absence Management Specialist at UPMC Health Plan and WorkPartners analyzes assigned claims to determine whether the case is medically supported for both leave and disability benefits. This role is responsible for the ongoing adjustment of claims within parameters set by the supervisor, as well as medical consultation with treating providers and referrals within program guidelines. Services include employee and manager counseling on all leave policies and processes, including short-term disability benefits, FMLA, state-sponsored leaves, and employer-sponsored leave benefits. The specialist also provides support to HR Professionals, manages employee and manager communications, tracks cases, and updates systems.

Requirements

Bachelors degree required (Equivalent experience will be considered in lieu of degree).
Technical knowledge of short-term disability claims management and/or leave management procedures
Strong communication and interpersonal skills, including ability to communicate clearly by telephone and in writing
Customer service oriented with the ability to handle emotionally charged situations
Strong medical knowledge
Knowledge of leave policies, federal and state laws pertaining to leave of absence
Excellent organizational skills
Excellent written and verbal communication skills
Ability to use and navigate web-based software programs and Microsoft Office products (Outlook, Word, Excel, etc.)
Certified Leave Management Specialist (CLMS) designation required within 12 months of hire.
To maintain designation, 20 hours of continuing education credits are required every two years.

Nice To Haves

2 years of leave management processing experience preferred
2 years of disability claims management experience preferred

Responsibilities

Participates in training activities to keep skill set updated.
Reviews claims in accordance with guidelines established by the client, state and federal regulations, as appropriate.
Provide consistent customer service to internal customers and employees through timely responses to all inquiries, telephone calls, e-mails and case follow-ups, while delivering on service commitments
Monitor Disability guidelines and when disability durations fall outside of standards, reviewing claims as appropriate with treating physician, clinical case manager or medical director.
Responsible for all communications with the employee, employees manager, human resources and all integrated partners e.g. disability management coordinator in the event of transitional return to work.
Reviews medical documentation in order to analyze, investigate and make decisions for the approval of benefits on initial, ongoing and re-opened claims.
Perform initial evaluation via phone with employee and employer for assigned cases. Review estimated disability duration and return to work potential.
Coordinates the leave process; verifies eligibility, determines leave approval, coordinates applicable client leaves polices including integration with state leave laws, and supports the return-to-work process.
Perform in accordance with system-wide competencies/behaviors.
Perform other duties as assigned.