Information Technology_USA - USA_Project Manager

Leave Claims Manager

Act as a subject matter expert for FMLA and Paid Family Leave policies

Interpret leave regulations and insurance guidelines for claim handling

Serve as a liaison between claimants, employers, and internal teams

Ensure compliance with US leave laws and company policies

Provide guidance on eligibility criteria and benefits structure

Handle escalations and complex leave cases

Support process standardization and policy adherence

Collaborate with clinical and business teams for case resolution

Contribute to continuous improvement initiatives in claims operations

Maintain high standards of customer service and communication

Manage absence case management and claim adjudication based on medical documentation

Review claim details including eligibility, claim type (intermittent or continuous), and supporting documents

Analyze medical records such as physician reports, diagnostic tests, and operative notes

Approve or deny FMLA and Paid Family Leave claims as per guidelines

Determine benefits due under US Paid Family Leave regulations

Handle Not in Good Order (NIGO) cases and obtain missing documentation

Communicate claim status and expectations via phone and written correspondence

Manage workload, client deliverables, and second-level escalations

Process payments, approvals, and adjustments for Workers Compensation and disability offsets

Refer complex cases to team leads or clinical case management

Perform quality checks and peer reviews for accuracy and timeliness

Support service level management and reporting requirements

Participate in special projects and process improvement initiatives

Experience in leave claims or absence management

Strong knowledge of FMLA and Paid Family Leave regulations

Understanding of disability claims and insurance processes

Ability to review and interpret medical documentation

Strong analytical and decision-making skills

Experience in claims adjudication and benefit determination

Knowledge of Workers Compensation and disability offsets

Excellent verbal and written communication skills

Ability to manage high-volume workloads

Attention to detail and accuracy

4-6 years or above