Integrated ADM Specialist

TELUS Health • Chicago, IL

14d • Remote

About The Position

The Integrated ADM Specialist is the primary subject matter expert and facilitator for the Americans with Disabilities Act (ADA) interactive process and the Pregnancy Workers Fairness Act (PWFA). The role also oversees, manages, processes, and adjudicates FMLA, state, and company-specific leaves, as well as straightforward and complex short-term disability (STD) claims, determining benefits due under an STD plan and ensuring ongoing claim processing.

The specialist analyzes leave requests and medical documentation, makes determinations under applicable federal and state regulations, and communicates with clients and claimants throughout the claims process. For ADA and PWFA matters, the specialist guides employees and clients through reasonable accommodation, advises on options, and supports integration between STD, leave, and accommodation requirements while mitigating legal risk.

This role conducts case assessments, coordinates with employees, managers, HR, medical resources, and client representatives, and supports return-to-work planning. It follows operating procedures and client-specific processes and participates in required team meetings and training. The work is primarily in a professional remote environment and involves sedentary, high-volume telephone and computer-based work, with emotional intelligence needed to manage sensitive and stressful situations involving employee health and legal compliance.

Requirements

• Minimum 5+ years of direct experience managing leave, STD, and ADA/PWFA claims or high-level disability case management.
• Computer skills and ability to work primarily online in a paperless environment.
• Strong interpersonal and helping skills, along with assessment and problem-solving skills.
• Deep understanding of the ADA, PWFA, FMLA, and state-specific leave laws.
• Experience managing self-insured STD plans and company-specific paid and unpaid leave policies.
• Ability to review and interpret medical documentation, translate clinical restrictions against essential job functions, and make workplace accommodation recommendations.
• Exceptional conflict-resolution and negotiation skills.
• Ability to handle sensitive medical information with extreme confidentiality and empathy.

Responsibilities

• Manage and process FMLA and other applicable federal leaves, military leaves, state leaves, company-specific leaves, and STD claims.
• Manage all FMLA Department of Labor category claims, including recertifications and second- and third-opinion processes.
• Manage ADA and PWFA claims by advising clients on reasonable accommodation options and recommending approaches for handling claims.
• Conduct case assessments by contacting employees and their managers or HR by telephone or email to explain the leave management process, employee responsibilities, and gather assessment information.
• Develop and document an understanding of each situation and factors that support or inhibit a successful return to work, considering essential job functions and undue hardship for the client organization.
• Review relevant information and consult appropriate medical resources, including nurse consultants, health professionals, and supervisors, to confirm decisions and recommendations on leave, STD, and ADA cases.
• Analyze FMLA medical certifications and other medical documentation and ensure claim determinations meet regulatory compliance timeframes.
• Inform STD claimants about documentation needed, timeframe requirements, claim status, approvals, denials, consultations, and other claim-related information.
• Determine return-to-work goals with employees and employers and actively support return-to-work planning between employees and supervisors, intervening when necessary.
• Serve as the primary case contact and communicate proactively and continuously with employer representatives about case management throughout the life of a claim.
• Follow operating procedures and processes described in training and meetings.
• Attend Case Management and Disability Management department meetings and training as required.
• Perform other projects and tasks as assigned.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed