Absence Management Specialist

UPMC • Pittsburgh, PA • 4h ago

UPMC Health Plan and WorkPartners is hiring a full-time Absence Management Specialist! This role will predominantly work remotely and will work standard daylight hours EST.

The Absence Management Specialist analyzes assigned claims to determine whether the case is medically supported for both leave and disability benefits. The Absence Management Specialist 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 the guidelines of the program. Services include employee and manager counseling on all leave policies and processes to include short term disability benefits, FMLA, state sponsored leaves and employer sponsored leave benefits. Provide support to HR Professionals, employee and manager communications, case tracking and system updates.

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.

*The above statement reflects the general details considered necessary to describe the principal functions of the job identified, and shall not be construed as a detailed description of all of the work requirements that may be inherent in the job, nor shall it be interpreted as limiting an employee in performing duties other than those normally performed or from helping employees in other position or units.

Bachelors degree required (Equivalent experience will be considered in lieu of degree).

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

Skills include: 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.)Licensure, Certifications, and Clearances:

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.UPMC is an Equal Opportunity Employer/Disability/Veteran

UPMC

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