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Integrated Absence Specialist- Remote

Remote: 
Full Remote
Contract: 
Full time
Salary: 
19 - 192K yearly
Experience: 
Senior (5-10 years)
Work from: 
Canada, United States

Offer summary

Qualifications:

High School Diploma or GED required, 3-5 years of FMLA experience.

Key responsabilities:

  • Manage and track eligibility for leaves
  • Administer claims per TRISTAR protocols
  • Assist clients with leave regulations
  • Update and reconcile claim files
  • Provide excellent customer service
TRISTAR Insurance Group logo
TRISTAR Insurance Group Insurance SME https://www.tristargroup.net/
501 - 1000 Employees
About TRISTAR Insurance Group
TRISTAR began as an insurance program manager and medical malpractice claims administrator in 1987. Workers compensation claims management services were added in our offerings in 1989, and the Company was renamed TRISTAR Risk Management in 1995. As managed care and benefits administration services were added to our offerings, the organization grew into TRISTAR. We are the largest privately held third party claims administrator in United States. We empower more than 1,000+ professionals in offices throughout the United States, focusing business operations in three divisions: property casualty claims management, benefits administration, and managed care services. We are true to our values of RESPECT, INTEGRITY, TRUST, and EXCELLENCE, making the right choices both financially and ethically. At TRISTAR we strive to create an environment of respect, wherein all of us are encouraged to learn and to grow, to provide exceptional service to our clients and in turn to enjoy the satisfaction that comes from a job well done. We believe that to provide real service, we must contribute something which cannot be bought or measured with money: sincerity and integrity. At TRISTAR, you help create a world in which together we "transform risk into opportunity".
See more TRISTAR Insurance Group offers

Job description

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Job Details
Level:    Experienced
Job Location:    Signal Hill Office - Signal Hill, CA
Position Type:    Full Time
Education Level:    High School Diploma or GED
Salary Range:    $27.50 - $28.85 Hourly
Travel Percentage:    None
Job Shift:    Day
Job Category:    Admin - Clerical
Integrated Absence Specialist- In Office or Remote (In Area)

Please navigate all the way to the end of the application process and sign your application.

 

This position is a remote position.  

Must have 3-5 years of FMLA experience required

 

POSITION SUMMARY:  Sets up and administers Leave of Absence, Voluntary Disability, Paid Family Leave, Short Term Disability and Long Term Disability Claims in accordance with TRISTAR ICS protocols and Employer specific service requirements.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

This position varies in responsibility starting with a Level I to a level IV, and may perform some or all of the duties in a more independent manner relative to their level, as listed below:

  •  Manages, tracks, and determine eligibility for all aspects of job protected leaves including federal, statutory, employer sponsored leaves (i.e. FMLA, CFRA, PDL, PLOA)
  • Incumbent is expected to administer a case load that meets industry standards of best practices (current range is up to 150 claims, eff. 2/2017)
  • Acts as a resource to clients and staff regarding the requirements and regulations of the above mentioned leaves with company benefits and internal leave policies
  • Follow established procedures and policies to administer disability/PFL claims in a timely and efficient manner.
  • Update leave/claim files and notes in the computer as appropriate.
  • Coordinate coverage and administration of insured programs with the appropriate carrier.
  • Review mail/email daily.
  • Establishes and maintains rapport with clients and their employees to ensure customer service goals are met.
  • Maintain and administer appropriate check cycle payments and procedures.
  • Reconcile overpayment/underpayment occurrence, which includes making payment arrangements, sending letters, and maintaining of overpayment/underpayment recap.
  • Coordinate return to work efforts with claimant, provider, and client
  • Answer all telephone claim calls from claimants, clients, and carriers within 24 hours.
  • Provide the highest quality of customer service.
  • Follow attendance policy: consistency in work schedule and punctuality.
  • All other duties as assigned.
Qualifications

QUALIFICATIONS REQUIRED:

Education/Experience:  High school diploma or GED (minimum).  One (1) year experience in administrative office environment for a Level I to  3-5 years leave management background for a Level IV.  

Knowledge, Skills, and Abilities:       

  • Must be organized and possess the ability to document files accurately.
  • Must have a general understanding of Federal and Statutory regulations regarding FMLA, CFRA, and PDL.
  • The ability to comprehend and integrate the above programs with VDI, STD, and VDI benefits.
  • Computer proficient in Word, Excel, and Web applications.
  • Ability to effectively communicate, both verbally and in writing with employees, supervisors, and external providers using tact and diplomacy when expanding decisions.
  • Ability to educate and counsel on sensitive and complex issues.
  • Good planning and organization skills to multitask in a high volume and fast paced work environment.
  • Ability to solve practical problems and to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Ability to understand Disability Plan Documents, SOC and ERISA Guidelines.

 

Here are some of the benefits you can enjoy in this role:

  • Medical, Dental, Vision, Disability & Life Insurance
  • 401(k) plan
  • Paid time off
  • Paid holiday

 

 

 

 

 

                                  MENTAL AND PHYSICAL REQUIREMENTS

1.  MENTAL EFFORT

 

a.  Reasoning development:

 

          Follow one- or two-step instructions; routine, repetitive task.

 

          Carry out detail but uninvolved written or verbal instructions; deal with a few concrete                            variables.

 

          Follow written, verbal, or diagrammatic instructions; several concrete variables.

 

 X      Solve practical problems; variety of variables with limited standardization; interpret instructions.

 

          Logical or scientific thinking to solve problems; several abstract and concrete variables.

 

          Wide range of intellectual and practical problems; comprehend most obscure concepts.

b.  Mathematical development:

 

          Simple additional and subtraction; copying figures, counting, and recording.

 

          Add, subtract, multiply, and divide whole numbers.

 

 X      Arithmetic calculations involving fractions, decimals, and percentages.

 

          Arithmetic, algebraic, and geometric calculations.

 

          Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.

 

          Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.

c.       Language development:

 

          Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.

 

          Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.

 

          Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.

 

 X      Ability to compose original correspondence, follow technical manuals, and have increased contact with people.

 

          Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.

2.  PHYSICAL EFFORT

 

a.       Physical activity required to perform the job:

 

          Sedentary work:  Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time.  Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

 

 X      Light work:

a.    Exerting up to 20 pounds of force occasionally

b.    Exerting up to 10 pounds frequently

c.    Exerting a negligible amount of force constantly to move objects

 

          (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).

 

          Medium work:

a.    Exerting up to 50 pounds of force occasionally

b.    Exerting up to 20 pounds of force frequently

c.    Exerting up to 10 pounds of force constantly to move objects

 

          Heavy work:

a.    Exerting up to 100 pounds of force occasionally

b.    Exerting up to 50 pounds of force frequently

c.    Exerting up to 20 pounds of force constantly to move objects

 

          Very heavy work:

a.    Exerting in excess of 100 pounds of force occasionally

b.    Exerting in excess of 50 pounds of force constantly to move objects

c.    Exerting in excess of 20 pounds of force constantly to move objects

 

    

  1. Visual requirements necessary to perform the job:

 

          Far vision:  clarity of vision at 20 feet or more

 

 X      Near vision:  clarity of vision at 20 inches or less

 

 X      Mid-range vision:  clarity of vision at distances of more than 20 inches and less than 20 feet

 

          Depth perception:  the ability to judge distance and space relationships, so as to see objects where and as they actually are

 

          Color vision:  ability to identify and distinguish colors

 

          Field of vision:  ability to observe an area up or down or to the right or left while eyes are fixed on a given point

 

 

 

2.  PHYSICAL EFFORT (cont.)

    FREQUENCY

c.        Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):

 

       Climbing:      Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms.  Body agility is emphasized.  This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.

 

       Balancing:     Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces.  This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.

 

       Stooping:       Bending body downward and forward by bending spine at the waist.  This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles.

 

       Kneeling:       Bending legs at knee to come to a rest on knee or knees.

 

       Crouching:    Bending the body downward and forward by bending legs and spine.

 

       Crawling:      Moving about on hands and knees or hands and feet.

 

       Reaching:      Extending hand(s) and arm(s) in any direction.

 

       Standing:       Particularly for sustained periods of time.

 

       Walking:       Moving about on foot to accomplish tasks, particularly for long distances.

 

       Pushing:        Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward.

 

       Pulling:         Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion.

 

       Foot

       Motion:          Using feet to push pedals.

 

       Lifting:          Raising objects from a lower to a higher position or moving objects horizontally from position to position.  This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.

 

 X    Fingering:     Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling.

 

 X    Grasping:      Applying pressure to an object with the fingers and palm.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Frequently

 

 

Occasionally

 

 

 

 

2.  PHYSICAL EFFORT (cont.)                  

      FREQUENCY

 X    Talking:         Expressing or exchanging ideas by means of the spoken word.  Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

 

 X    Hearing:        Perceiving the nature of sounds with or without correction.  Ability to receive detailed information through verbal communication and to make fine discriminations in sound, such as when making find adjustments on machined parts.

 

       Feeling:         Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.

 

 X    Repetitive      Substantial movements (motions) of the wrists, hands,

       Motion:         and/or fingers.

Regularly

 

 

 

Regularly

 

 

 

 

 

 

 

Frequently

 

 

 

Required profile

Experience

Level of experience: Senior (5-10 years)
Industry :
Insurance
Spoken language(s):
Check out the description to know which languages are mandatory.

Soft Skills

  • Customer Service
  • Computer Literacy
  • Planning
  • Verbal Communication Skills
  • Problem Solving
  • Multitasking
  • Management
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