Paid Medical Leave Disability Specialist

Are you an experienced Paid Medical & Family Leave (PMFL) Adjuster or Case Manager looking for your next opportunity? Broadspire is expanding and looking for professionals who are passionate about helping employees through important life events.

Why Broadspire?

Competitive compensation
Remote opportunities available
Advanced technology and AI-powered tools
Strong leadership support
Career growth and development opportunities
Collaborative team environment
Backed by a nationally recognized organization

If you have PMFL experience and are looking for a company that values your expertise, provides exceptional support, and offers opportunities to grow, we'd love to connect.

Make an impact
Grow your career
Join the future of leave administration with Broadspire

• Bachelor's degree or equivalent experience required.
• 2 + years of STD/LTD claims adjudication
• Experienced in the TPA or self-administration services is desired
• Experience with FMLA/State leave claims is a plus
• Aptitude for learning medical terminology and conditions, as well as interpreting procedures and regulations
• Ability to work independently while assimilating various technical resources
• Computer knowledge in excel, word, web based systems, etc
• Good verbal and written communication skills
• Knowledge of ERISA regulations, required offsets and deductions, disability duration and Social Security procedures
• Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action.
• Strong ability to identify, analyze and solve problems.
• Effective interpersonal skills capable of dealing with external sources and all levels of employees.

• Manages assigned caseload of disability claims for Short Term/Long Term Disability.
• Communicates with claimants, employers, and various medical professionals to gather information regarding eligibility, benefit authorization, and ongoing management of STD or LTD benefits.
• Applies the appropriate contractual provisions; case management resources; and claim processes to ensure eligibility requirements and liability decisions are accurate.
• Provides superior customer service by rendering benefit determinations within expected timeframes and quickly responding to all inquiries.
• Demonstrates ability to independently manage disability claim and apply clinical guidance as provided on more complex claims.
• Verifies on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc. to discuss return to work opportunities as appropriate.
• Uses disability claim system to manage and authorize payment on claims while meeting all service, timeframe, and productions standards
• Ensures a timely and appropriately coordinated transition of claims from STD to LTD, providing a well -managed and seamless claims experience to claimants.
• Analyzes claims activity and prepares reports for clients/carriers and management as needed
• Becomes familiar with specialized client instructions and performance guarantee standards for any assigned clients. Serves as a resource for trainees and Claims processors as needed.
• Effectively works together in a team setting.
• Other duties as assigned.