Under general supervision, review, research, analyze, and evaluate the corporate and client benefits plans.
Responsible for the administration of all disability policies to include FMLA, ADA, Work Compensation, OHSA logs and other leave plans.
Manage leave plans for 3 business entities from concept to implementation with FMLA review and determination done in-house.
Function as the liaison between vendors and employees.
Advise employees on eligibility and coverage related to leave of absence, ADA accommodation, and other benefit matters.
Assist with compliance and other regulatory interpretations and audits.
Review and analyze leave of absence trends for monthly reporting.
Prepare and analyze leave of absence and workers compensation reports and metrics.
Lead and coach team members, HRBP's and managers on leave of absence regulations and guideline related to leave of absence, fitness for duty, and ADA accommodation decisions.
Responsible for managing the interactive accommodation review process and deciding appropriate reasonable accommodations for employees with restrictions and limitations request/needs.
Stay abreast on applicable legislation and regulations pertaining to FMLA and ADA.
Conduct monthly LOA/WC training for managers to meet training and compliance requirements for 3 separate business entities.
Assist with creation of templates, policies, procedures and forms for restructuring of leave of absence administration and compliance.
Provide weekly LOA payroll reporting for reconciliation of payroll processing for those employees on continuous or intermittent leave.
Communicate benefit premiums to employees on leave for payment processing and maintenance.
Other duties to include providing back up to other areas within the HR/Benefits department.
08/2013 to 04/2014
Benefits SpecialistCROSSMARK － Plano, TX
Administer FMLA and Short term disability, military and personal LOA functions.
Manage the interactive accommodations review process to ensure ADA guidelines/regulation is adhered to for associates that require accommodations.
Consult and advise associates on benefit related inquires/issues.
Handle escalated matters related to leave of absence, payroll, benefit deductions/issues and accommodation review process.
Work closely with Risk Management and Employee Relations on leave of absence and worker's compensation issues to resolution.
Run daily metric reporting, serve as subject matter expert on all LOA related issues.
Verify calculations of monthly premiums statements for all group insurance policies.
Administer benefit plans including maintenance of benefit enrollment system, monthly billing processing and reconciliations, and monitor compliance of employee benefits programs will all legal requirements (COBRA, FMLA, ADA, HIPAA, etc.) Help with the coordination and administration of annual open enrollment process.
Assist with the planning of annual benefits fair and open enrollment information sessions.
Respond, research, and answer departmental email receipt.
Other projects and duties as assigned.
09/2012 to 01/2013
Contract SpecialistHumana － Louisville, KY
Responsible for review and process of Medicare approved plans and options to existing and new contracts to the network by applying technical expertise for solving complex problems.
Review and research of conflicting contract data by using interactive reporting, adhoc exception reports and internally created inventory reports.
Maintain current processing standards of all new and existing contract data within established department metrics of 99.7% QA score.
Assist with special projects as identified by manager.
06/2009 to 09/2012
FMLA Group Claims AssociateCigna Leave Solutions － Plano, TX
Manage disability claim caseload for various clients (500-800 ongoing open cases) within contractual agreements for short/long term disability benefits concurrent with FMLA and state leave regulations.
Determine eligibility requirements are met and communicate to claimant in writing and via telephone.
Input claimant medical and demographic data evaluating eligibility of federal and state leaves.
Address obstacles with claimant, attending physician and employer; monitor claimant's medical conditions, discuss claimant's work return with employer; integrate individual rehab/return to work plans into ongoing medical treatment; monitor other state disability income benefits; decide payment period's accuracy and timeliness; follow claimant's leave to closure.
Respond to client and external vendor inquiries with time standards; evaluate absence while reviewing all medical information and determine claim approval or denial while adhering to all legal/compliance requirements for short-term/long-term disability and FMLA benefits.
Maintain FMLA and absence in claim system, including comprehensive and detailed paperwork to evaluate and assess claim processing and medical treatment plan.
Maintain mandatory quality standard of 95% or better and meet 100% compliance/production standard.