FML Leave Manager

Guardian Life Insurance

10d • Remote

About The Position

Please note: The starting pay rate for this position is projected to be $21.64 per hour, with a 3% annual bonus target. Our contact center is known for delivering outstanding customer service experiences, and we want to work with others that have a drive to be the best at what they do. We have an opportunity in the role of FML Leave Manager responsible for proactively managing Leave of Absence programs and individual FML cases based on plan provisions, state and federal guidelines, and established protocols. You will Interact and consult with key partners including Clients, Claimants, Nurse and Disability Case Managers, Risk Management. Administer claims within a variety of group sizes, but is primarily assigned core and middle market cases, and is responsible for ensuring all regulations and guidelines continue to be met through the duration of the claim. Utilize problem solving, analytical, written, and verbal communication skills to deliver timely and appropriate leaves management decisions while providing outstanding customer service to all internal and external customers. Maintain case oversight and acts as the critical communication link, in conjunction with the assigned Disability Case Manager where applicable, for all parties in FMLA client absence programs including employees, client company, health care providers and clinical partners. Ensure legal compliance, provides timely notifications to employees and client companies, reviews documentation for approvals and denials, responds to periodic audits. Make recommendations for second and third opinions, independently and when indicated and concurred with by the Manager. Maintain FMLA and absence information in Absence Manager Software System, including comprehensive activity notes. Provide reports detailing essential information on open and closed absences. Manage intermittent occurrences in accordance with approved certifications and identifies trends or abuse patterns. Identifies potentially fraudulent cases. Communicate with claimants, plan holders, and physicians as needed for information needed for initial and ongoing leave management.

Requirements

• Minimum of 1+ years' experience working with group disability or absence management, medical disability services or similar preferred; knowledgeable of governing regulations and medical terminology.
• Previous case management, customer service or call center experience desired.
• Ability to clearly communicate claim decisions and contract language verbally and in written correspondence.
• FMLA and Group Disability claim experience or group benefit product knowledge strongly preferred.
• Regulatory and Compliance experience a plus.
• Understanding of medical terminology and medical conditions helpful.
• Strong interpersonal and PC skills (e.g., Microsoft Word & Excel)

Nice To Haves

• Bi-Lingual a plus.

Responsibilities

• Proactively managing Leave of Absence programs and individual FML cases based on plan provisions, state and federal guidelines, and established protocols.
• Interact and consult with key partners including Clients, Claimants, Nurse and Disability Case Managers, Risk Management.
• Administer claims within a variety of group sizes, but is primarily assigned core and middle market cases, and is responsible for ensuring all regulations and guidelines continue to be met through the duration of the claim.
• Utilize problem solving, analytical, written, and verbal communication skills to deliver timely and appropriate leaves management decisions while providing outstanding customer service to all internal and external customers.
• Maintain case oversight and acts as the critical communication link, in conjunction with the assigned Disability Case Manager where applicable, for all parties in FMLA client absence programs including employees, client company, health care providers and clinical partners.
• Ensure legal compliance, provides timely notifications to employees and client companies, reviews documentation for approvals and denials, responds to periodic audits.
• Make recommendations for second and third opinions, independently and when indicated and concurred with by the Manager.
• Maintain FMLA and absence information in Absence Manager Software System, including comprehensive activity notes.
• Provide reports detailing essential information on open and closed absences.
• Manage intermittent occurrences in accordance with approved certifications and identifies trends or abuse patterns.
• Identifies potentially fraudulent cases.
• Communicate with claimants, plan holders, and physicians as needed for information needed for initial and ongoing leave management.

Benefits

• At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.
• As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.
• Explore our company benefits at www.guardianlife.com/careers/corporate/benefits.

What This Job Offers

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