Job Details

Summary The Case Manager will oversee, manage, process, and adjudicate FMLA, State, municipal and company specific leaves, as well as straightforward and complex STD claims; to determine benefits due pursuant to an STD plan and to ensure the ongoing processing of claims. The role includes analyzing reported Family Medical Leave (FMLA) requests, making determinations based on Federal and State regulations, communicating clearly with clients and claimants on all aspects of the claims process, and ensuring that ongoing claim management is within Standard Operating Procedures (SOPs) and Service Level Agreements (SLAs). The case manager also assesses any barriers to a successful and timely return‑to‑work and engages with stakeholders to implement strategies to address those identified barriers and support return to work or an appropriate alternative plan.Responsibilities Manage and process FMLA and other Federal leaves as applicable, including Military leaves, State leaves, company‑specific and STD claims.With regard to FMLA, manage all DOL category claims, including re‑certifications and the 2nd and 3rd opinion processes.Conduct case assessments by contacting the employee and their manager/HR by telephone or email to explain the leave management process, employee accountabilities, and gather information for assessment purposes.Develop and document an understanding of the situation and the factors supporting, as well as inhibiting, a successful return to work for the employee.Review all relevant information and consult with appropriate MSI resources (nurse consultants, health professionals, supervisory team) to confirm the decision (approved/denied) recommendation on FMLA, State, company‑specific leaves and STD cases.Analyze FMLA medical certifications and other medical documentation and ensure claim determination adheres to the required regulatory compliance timeframes.Inform STD claimants of any documentation needed to process a claim, timeframe requirements, claim's status (e.g., STD approvals, denials, and consults), or any other information necessary to manage a claim.Determine an appropriate RTW goal with the employee and the employer; provide active support for the return‑to‑work planning process between the employee and their supervisor and intervene when necessary.Communicate proactively with the employer's HR representative regarding any case management issues that may impact the workplace and RTW planning.Follow all processes as laid out in the Standard Operating Procedures (SOPs) and/or as detailed in trainings/meetings.Attend Case Management and Disability Management department team meetings and trainings as required.Perform other projects and tasks as assigned.Qualifications 2+ years of comprehensive experience in U.S. leaves and disability case management and knowledge of the various legislative requirements.Strong interpersonal and helping skills along with superior assessment and problem‑solving skills.Excellent computer skills and ability to work primarily online in a paperless environment.Associate's degree or registered professional status within the disability management or professional health sector.Additional coursework in occupational health, rehabilitation, legislation related to disability management, helping relationship skills, mediation, human resource management, disability insurance, psychological and workplace factors in disability (asset).Bilingual (English and Spanish) – considered an asset.Management of ADA/ADAAA claims – considered an asset.Western U.S. home‑based preferred.Equal Opportunity Employer TELUS Health is an Equal Opportunity Employer that aims to foster an inclusive culture that embraces diversity. It is our policy to hire without regard to race, color, creed, religion, national origin, citizenship status, sex, marital status, age, disability, sexual orientation or veteran status.Accommodation for Applicants with Disabilities We offer accommodation for applicants with disabilities, as required, during the recruitment process.#J-18808-Ljbffr