Job Description
Opportunity Description
Lead Leave Management Specialist is responsible for the non-Occupational, Workers’ Compensation and assistance with the operations of the department to ensure efficiency and that the on-going claim management is within organizational standards and in compliance with state and federal regulations.
Company Information
Hospitals & Healthcare
Job Duties
- Oversee and provide total leave of absence claim management - from first notice and intake to closure.
- Obtain and review updated medical evidence of reason for leave upon receipt for assigned claims.
- Review guidelines for eligibility resulting in accurate eligibility decisions. Handles more complex leave cases requiring use of sound judgement, based on knowledge, skills, and prior experience
- Serve as the point of contact for LOA Administrators, Management, Human Resources, Legal, and plan vendors regarding leaves of absence related processes.
- Provide support to Leave of Absence Specialists and training on appropriate procedures for all types of leaves.
- Responsible for LM Network training including updating LM Process Training Manual for new hires.
- Responsible for training staff on new systems and documentation of process.
- Maintain accurate records and reporting of employee leaves in full legal compliance.
- Develop, generate, and present reports to analyze leave data and trends including current leaves, returns from leaves, and intermittent leave implications (staffing, return to work, etc.).
- Create and manage dashboard reports for management review.
- Serve as the subject matter expert for the leave program in alignment and under the general direction and guidance of the Manager of Leave Management
- Ensures highest level of customer service with supervisors/managers and provides responsive support throughout LOA process.
- Review, update, and maintain knowledge of all LOA policies to ensure legal compliance, ensure proper distribution, and integration with all other departments
- Oversee integration of leaves (i.e. workers’ compensation with FMLA) and integration with other functions (benefits during LOA, payroll, etc.).
- Takes part in continuing education on LOA topics and ensures 100% federal and state compliance in all areas in which the organization operates.
- Acts as the primary point of contact for each injured employee for the duration of their workers’ compensation claim; acts as liaison between injured employee and workers’ compensation adjuster; and follows up with injured employee as needed to ensure claim is progressing properly.
- Analyze and process workers’ compensation claims by investigating and gathering information to determine compensability and exposure.
- Investigate claims to determine an injured worker’s entitlement to Workers’ Compensation benefits; administers indemnity and medical benefits for valid Workers’ Compensation claims.
- Responsible for receiving, organizing, and analyzing all files and documents related to the injured worker and the injury in order to make an effective and accurate determination concerning the claim.
- Perform interview with the injured employee to obtain a detailed description of how the injury occurred.
- Perform other duties as assigned or required
Education
Bachelor’s Degree Required
Experience & Skills Required
- 3 years of extensive administrative experience and a background providing comprehensive support in Leave Management.
- Experience compiling and analyzing large volumes of information and streamlining processes/tasks to maximize productivity.
- Communicator possessing advanced technology skills with ability to prioritize multiple assignments in high volume, fast-paced environment while meeting deadlines
- Highly organized and able to think systematically to structure the work and design in a logical flow.
- Demonstrated proficiency in MS Office products (Word/Excel), internet, and website navigation required.
- Energetic, driven personality with a demonstrated ability to take initiative, successfully handle and prioritize multiple competing assignments and effectively manage deadlines.
- Outstanding verbal and written communication skills required with the ability to successfully interact at all levels of the organization while functioning as a team player.
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