Team Leader - Operations

Position Summary

ADA Specialists/ ADA Consultant partner with the employee and employer to gather and communicate the facts about the accommodation need/request, substantiate the medical need for an accommodation, evaluate accommodation options/costs (including alternative options), & manage documentation and supporting material.

Job Responsibilities

Basic Function

• Administer ADA (Americans with Disability Act) standalone claims
• Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems.
• Promptly review new ADA, evaluate against appropriate leave plans and make initial claim decision.
• Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc.
• Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
• Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
• The position is expected to do absence management and adjudication on Federal, State and company leaves.
• Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician’s office
  
  

Essential Functions

• Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
• Analyze and research all discrepancies
• Research & Investigate and resolve outstanding items
• Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
• Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
• Establish action plans for each file to bring claims to resolution
• Utilize internal and external specialty resources to maximize impact on each claim file
• Use PC programs to increase productivity and performance
• Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
• Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
• Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and meeting key measures
• Ensure adherence to established attendance schedules
• Close visual activity - viewing a computer terminal and extensive reading
  
  

Any other essential function that may occur from time to time as directed by the Supervisor.

Primary Internal Interactions

• UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
• Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
• Subject Matter Expert for the purpose of work thread related issues and escalated transactions
• QCA for the purpose of feedback and internal Performance Guarantee quality audit team
• Trainers for the purpose of Pre-process and Process DCA training
• Disability Customer Advocates for escalation resolution
  
  

Primary External Interactions

• End customer to be contacted through emails/calls for information gathering/decision update
• Claims specialist & other Stateside Teams on emails/calls
• SME / Trainers at the client end for training
  
  

Education, Technical Skills & Other Critical Requirement

Education

Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.

Experience

(In Years)

Minimum 3-4 years of experience in customer service background of insurance or related industry with relevant experience of working in a business environment (preferred but not compulsory)

Technical Skills

• Good computer navigation skills
• Good keyboarding speed
• Good knowledge of complete MS Office suite
  
  

Process Specific Skills

• Knowledge about the Insurance industry in US
• Knowledge about US Culture
• Knowledge of Insurance principles

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