Absence Case Specialist

Location: Wellesley MA

Onsite Flexibility: Remote open to anyone in the U.S. as long as they can work EST hours

• Position Type: Contract
• Contract Duration: 6 months (with potential for extension)
• Pay Rate: $30.00 / Hour (USD)
• Shift / Schedule: Monday Friday 8:30 AM 5:00 PM EST
• Work Authorization: Applicants must be authorized to work for ANY employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

The Absence Case Specialist works with employers employees and health care providers to administer an integrated Family and Medical Leave Act (FMLA) rights and responsibilities and Short Term Disability claim. Provides advice and counsel regarding leave administration and effectively coordinates all cases/claims in compliance with the FMLA and all related employment laws. Responsible for the professional management of both routine and complex claims for Group Short Term Disability while working both independently and in a team to ensure superior service to policyholders and claimants. Reviews claims and makes final determination for admittance or denial. Approves payment of claims and Company liability within established limits.

The role possesses excellent Disability and Absence Management knowledge with demonstrated expertise in Federal/State FMLA short-term disability statutory disability plans and ADA. The role works within a team environment among a peer group and business partners with related subject matter expertise to service client needs related to absence disability and accommodations.

• Interprets and administers leave programs and policies in accordance with the applicable federal and state employment laws (FMLA ADA USERRA Pregnancy Discrimination Act etc.).
• Facilitation and engagement in interactive dialogue with employees medical professionals supervisors and HR business partners to assist employees.
• Documentation of the request for absence including detailed points of contact and actions taken to coordinate the accommodation request.
• Reviews claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims.
• Sets claim action plan to ensure that determinations are adjudicated in a timely accurate and efficient manner.
• Interprets contracts and ensures consistent fair claims practices and adherence to appropriate laws regulations and procedures.
• Obtains backup documentation as necessary to substantiate claim or to provide service by communicating via telephone with agents employers (policyholders) claimants hospitals physicians attorneys and other resources.
• May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs.
• Protect and maintain personal health information with a high level of confidentiality abiding by Sun Life procedures and by HIPAA rules and regulations.
• Other duties and responsibilities as assigned.

• 12 years of customer / financial services experience.
• Effective ability to use legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology in order to make final decisions to approve or further investigate claims.
• Demonstration of strong mathematical skills for calculations and adjustment of claim payments.
• Strong computer skills proficient in PC environment and MS Word Excel and email systems.
• Communicating effectively and professionally with a wide variety of both internal and external business partners peers and resources.
• Attention to detail with documentation reporting and communication.
• Facilitation skills in a variety of circumstances and with a wide variety of input; ability to influence and teach.
• Self-directed with an ability to work independently and make independent judgments and decisions.
• Strong organizational skills including the ability to prioritize work and multi-task.
• Strong research analytical critical thinking problem solving skills and decision-making skills.
• Ability and desire to work in a fast-paced service-oriented environment.
• Excellent verbal communication skills with the ability to be both pleasant and professional.
• Strong written communication skills.
• Strong interpersonal and customer service skills.
• Ability to initiate and prioritize regular work duties and projects.
• Detail oriented organized the ability to multi-task and strong time management skills.
• Ability to work professionally and effectively with co-workers clients claimants vendors and others.

• Healthcare insurance TPA employer leave administration or carrier experience preferred.
• Claims background and medical terminology.

• Bachelors degree preferred but not required.

• 12 years of customer / financial services experience required.

• Claims experience is ideal particularly with short-term disability or medical claims; if not client-facing experience is applicable.
• Healthcare insurance TPA employer leave administration or carrier experience.

• While performing the duties of this job the employee is required to stand move from one room to another and frequently sit.
• The employee must talk or listen and use hands to finger handle or touch in the context of navigating a computer keyboard and phone system.
• The employee must be able to understand the spoken word written word both hard-copy and on-line and must be able to respond in kind.
• The employee must be able to operate standard business equipment including a computer and a variety of software applications.

• 6 weeks of training included upon hire.
• Candidates must demonstrate empathy and strong problem-solving ability.
• As part of the interview process agencies are responsible for conducting candidate interviews. All interviews must be conducted verbally and interview questions must not be shared with candidates in advance under any circumstances. Following the interview agencies are required to document each question along with the candidates corresponding response in a Q&A format. This completed interview summary should be included on the first page of the candidates resume when submitted for consideration.

• Medical Vision and Dental Insurance Plans
• 401k Retirement Fund

This client is a leading global financial services organization offering insurance investments and asset management solutions across multiple markets worldwide. With a broad geographic footprint spanning international markets the organization employs thousands of professionals in roles including claims specialists absence management advisors financial analysts customer service representatives and operations staff who collaborate across integrated service and support teams.

GTT is a minority-owned staffing firm and a subsidiary of Chenega Corporation a Native American-owned company in Alaska. We highly value diverse and inclusive workplaces and support Fortune 500 organizations across banking financial services technology life sciences biotech utilities and retail sectors throughout the U.S. and Canada.

Job Number: 26-14847

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