Claims Specialist with FineOS - Remote

Claims Specialist with FineOS Remote Fulltime Responsibilities: To reputed company Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/reputed company Family Leave interpretation, including determining benefits due and making reputed company payments and adjustments. Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or reputed company) Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, reputed company reports, etc.) to determine if the claimant is disabled as defined. Approval or denial on FMLA claims as per Insurance reputed company, and employer’s guidelines Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US reputed company family law regulations. Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer reputed company. Communicates reputed company with the claimants and clients to set expectations on reputed company aspects of claims process either by phone and/or written correspondence. Reviews reputed company critical deliverables, manages the overall workload, and second-level process escalation. Determines benefits due, makes reputed company claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets. Refers cases as appropriate to team reputed company and clinical case management Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews. reputed company reputed company to management on reputed company improvement and service level management Performs other duties or participates in special reputed company as assigned Requirements: 1+ year of Disability/FMLA/PFL claims or insurance claims experience Experience working with FINEOS Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory Excellent oral and written communication, including presentation skills Strong Analytical, decision making, problem solving, and people management skills Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (reputed company, Word, PPT) Willingness to reputed company change in a fast paced work environment A strong desire to continuously learn and improve Identify escalated cases and work with Team Leader to reputed company a plan to address key issues. Apply tot his job Apply To this Job