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Leave of Absence Claims Examiner

Location:AUSTIN, TX
Salary Range:DOE
Employment Type:Full Time
Department:FMLA/Leave of Absence
Description:The Leave of Absence/FMLA Claims Examiner will act as a liaison between client, employee and healthcare provider. This position is accountable for the decision making process for determining eligibility under federal, state laws and client policy. Documentation, medical certification and leave tracking will be managed by the Claims Examiner within the Matrix tracking system.
Duties:• Investigate, evaluate and determine benefit eligibility of the Leave of Absence claims in a timely fashion.
• Determine eligibility under federal and state requirements for leaves submitted.
• Medical certification review and management supplied by the healthcare provider.
• Determine the duration associated with the leave based on the information given by the healthcare provider.
• Communicate approvals, denials, leave extensions, return to work plans and other important information regarding the claim to the employee and client.
• Manage leaves that are concurrent with Short Term Disability and Workers’ Compensation.
• Manage intermittent, continuous and client specific leaves of absences.
• Process all absences within the specific timeframes outlined within Matrix Best Practices guidelines.

Other duties as assigned.
Qualifications:• College degree required. Bachelor’s degree preferred.
• Minimum of 2 to 5 years experience working in Human Resources or in the capacity of a Claims Examiner.
• Thorough understanding of Short Term Disability (STD) process required.
• Knowledge of federal and state laws pertaining to leaves of absence.
• Ability to gather, analyze and organize data to make educated decisions.
• Ability to identify critical issues and exercise independent judgment.
• Ability to work independently and manage a workload effectively required.
• Ability to come to work daily and sustain regular attendance is required.
• Excellent presentation and written/verbal communication skills.
• Proven experience in providing internal and external customer service.
• Ability to handle confidential information with the utmost judgment and discretion.
• Knowledge of medical terminology desired.

Matrix Absence Management is a nationwide company that partners with employers to provide customized management of disability, workers’ compensation and family leave programs.

We service a wide range of nationwide clients. Our clients include Fortune 500 companies, Technology sector leaders, Service Companies, Manufactures, Bio Tech, Utilities and Healthcare.

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