Description :

1. Administrated all leaves of absence include: medical, FMLA, STD, LTD, military, unpaid personal leaves, jury duty, bereavement and workers compensation.
2. Coordinated all aspects of employee leave including FMLA, short-term disability, long-term disability and paid and unpaid leaves of absence.
3. Ensured currency and compliance of all federal and state Human Resource laws (Section 125, COBRA.
4. HIPAA, FMLA, ADA, etc) as they relate to the administration of all benefit plans and related plan documents.
5. Assessed, adjudicated, tracked and monitor all FMLA and other LOA claims.
6. Maintained knowledge of all HR systems, applications and tools (PeopleSoft, Peregrine, Workbrain/Tomas, Legacy, Metafile, Taleo, and Sales Force).
7. Provided direct support to a HR leader and requires the ability to maintain strict confidentiality in handling highly-sensitive, privileged and confidential information regarding the company and its team member.

Experience

10+ Years

Level

Senior

Education

High School DIploma

Description :

1. Served as subject matter expert in compliance and processing of all background screening and drug testing issues, benefit and payroll related court orders, subpoenas and employment verifications, subpoenas, state auditing requests, unemployment requests and department of transportation (DOT) requests.
2. Collaborated with state and federal government as needed for auditing and other purposes.
3. Processed leave requests from associates, and from management on behalf of associates.
4. Verified necessity of leave through acquisition of comprehensive and accurate medical documentation.
5. Communicated decisions and on-going expectations with claimants and clients.
6. Maintained professional client relationships Assist caller with enrollments and general questions on all benefit plans.
7. Maintained general knowledge of all benefit plans.

Experience

10+ Years

Level

Senior

Education

High School Diploma

Description :

1. Managed assigned caseload of complex, integrated STD (Short Term Disability), DBL, TDB and Absence leaves: FML, USERRA, state leaves (CT FML, CA PFL, CA PDL, HI PDL, etc) and in-house personal leaves as a third party contractor for companies across the entire United States.
2. Worked efficiently and effectively under strict time constraints to both evaluate and process initial leave eligibility and initial decision of claim.
3. Communicated very closely with physicians and other licensed professionals in regards to claimant's health condition and medical documentation required for processing of claims.
4. Established and maintained a good rapport with HR staff as well as the employee on leave.
5. Continued with open lines of communication for possible early return to work, extension of leave and benefits, death or even termination of employment.
6. Offered guidance and recommendations to HR staff regarding any concerns or issues involving an employee's leave and possible disciplinary actions.
7. Worked closely with designated HR staff to ensure employee's return to work with any temporary or permanent modified duty or work restrictions.

Experience

2-5 Years

Level

Junior

Education

BS

Description :

1. Manage assigned caseload of complex, integrated STD (Short Term Disability), DBL, TDB and Absence leaves: FML, USERRA, state leaves (CT FML, CA PFL, CA PDL, HI PDL, etc) and in-house personal leaves as a third party contractor for companies across the entire United States.
2. Worked efficiently and effectively under strict time constraints to both evaluate and process initial leave eligibility and initial decision of claim.
3. Communicated very closely with physicians and other licensed professionals in regards to claimant's health condition and medical documentation required for processing of claims.
4. Established and maintained a good rapport with HR staff as well as the employee on leave.
5. Continued with open lines of communication for possible early return to work, extension of leave and benefits, death or even termination of employment.
6. Offered guidance and recommendations to HR staff regarding any concerns or issues involving an employee's leave and possible disciplinary actions.
7. Worked closely with designated HR staff to ensure employee's return to work with any temporary or permanent modified duty or work restrictions.

Experience

2-5 Years

Level

Junior

Education

BS In Early Childhood Education

Description :

1. Planned and organized work so the Service Level Agreement Objectives are realized.
2. Utilized knowledge, internal training, and system resources to provide the best customer support.
3. Leveraged Systems tools to perform front-line customer support functions.
4. Received, resolved and/or appropriately route inbound Leave of absence calls.
5. Ensured all work is performed in accordance with targets.
6. Worked to obtain first call resolution when answering calls.
7. Diffused difficult situations and quickly change the direction of the call toward a satisfactory resolution.

Experience

5-7 Years

Level

Executive

Education

High School Diploma

Description :

1. Analyzed reported Family and Medical Leave Act requests.
2. Continuously make best informed determinations based on federal and state laws and regulations.
3. Ensured that that on going claim management lies within company service standards and industry best practices.
4. Established and maintained 100 FMLA claims per week.
5. Tracked and coded documentation in accordance with client contract.
6. Analyzed FMLA claims to determine eligibility and certification in compliance with federal and state laws and regulations.
7. Improved processing efficiency by 10% each quarter.

Experience

2-5 Years

Level

Executive

Education

Bachelors

Description :

1. DAY Administered and managed FMLA, medical, and military leaves.
2. Served as the primary point of contact for and manage all leave requests and track in accordance with all the Federal and State legislation including responding to leave with necessary forms/ correspondence, request missing information and follow up on return to work status.
3. Ensured company is compliant with all federal, state and local laws and regulations.
4. Understood, communicated, educated and supported Sedgwick policies and programs.
5. Maintained confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA) Identifies action plan.
6. Determined benefits due.
7. Made timely case decisions based on service expectations as established by the client.

Experience

7-10 Years

Level

Management

Education

Diploma In General Studies

Description :

1. Included implementation multi-state leave laws, as well as ICS cleint leave and disability programs for compliance of FMLA, leave requests.
2. Processed and entered paper reports to track (projects) PFL/Disability/LOA Claims via excel.
3. Retained LOA documentation for accuracy of compliance reports to employer(s).
4. Made LOA decisions in conjunction with claim decisions if applicable and relavent to provisional approvals, denials, and eligibility issues and return to work flow on all requested LOA/FMLA/CRFA/PDL leaves.
5. Provided customer service for employee/employer inquiries in a timely manner.
6. Interfaced with claims examiners and processors.
7. Responsible for executing leave related business transactions with associate customer base.

Experience

2-5 Years

Level

Executive

Education

BS In Business Administration

Description :

1. Administered leave of absence benefits while adhering to company, state, and federal guidelines.
2. Selected to develop and implement a new process for facilitating team meetings resulting in increased peer engagement and camaraderie.
3. Provided process steps and supplied data for the Kaizen project resulting in decreased response time for receipt of medical leave documents.
4. Developed into subject matter expert for pregnancy related leaves and developed new reporting procedures resulting in increased accuracy in communication.
5. Exceeded quality metrics exemplifying accuracy in work completed.
6. Managed, evaluated, and tracked employee leaves of absence for the FMLA (Family Medical Leave Act) and all other applicable state and corporate laws for over 1100 retail stores.
7. Processed all leave paper work from the request process through leave completion, including regular follow-ups, returns to work, and terminations.

Experience

7-10 Years

Level

Management

Education

Bachelor's In Business Management

Description :

1. Assisted client employees with various Leave of Absence processes, including Short Term Disability and Family Medical Leave, as well as other company specific leaves.
2. Worked with Claim Managers, Worker's Compensation, Doctors, and Nurses to assist employees during their leaves by obtaining medical documentation to support STD/FMLA claims.
3. Met and exceeded all metric goals every month, including Adherence and Call Quality.
4. Received monthly recognition for having the most Positive Customer Feedback, Kudos, in the department.
5. Answered a high volume of telephone calls, data entry, general office duties, etc.
6. Reviewed and analyzed medical certifications and documentation pertaining to leave.
7. Determined and assigned leave statuses under the FMLA and state regulations.

Experience

2-5 Years

Level

Executive

Education

BS In Psychology