Paid Family Leave Claim Examiner (DC10318) job in confidential

Paid Family Leave Claim Examiner opening in Long Island, NY. Position is accountable for analyzing DBL & PFL information, investigate and secure claimant, employer, and healthcare provider information required to adjudicate DBL/PFL claims. Review claimant, employer and medical information along with other documentation submitted to determine DBL/PFL eligibility, claim duration & benefits payable. Understand and apply department processes, policies and regulatory provisions. Make determinations to approve, pend, or deny claims consistent with department turn-around and accuracy standards on all assigned claims. Manage continuous claims and/or intermittent DBL/PFL claims, including obtaining additional information as required. Accurately and thoroughly document claim file actions and conversations. Escalate issues / complex claims to Claim Manager. Promote a positive customer experience through prompt, accurate and courteous services to both internal and external customers. Audit vendor claims for payment accuracy and procedural accuracy. College degree preferred or an equivalent of at least three years of work experience, 1-2 years’ experience in a medical/disability claims environment. Knowledge of federal and state laws pertaining to leaves of absence as well as medical terminology preferred. Professional written and verbal communication and interpersonal skills. Strong reading, writing, and arithmetic skills required. Ability to interpret and administer policy/plan provisions. Ability to calculate earnings, benefit levels and FICA taxes. Ability to gather, analyze and organize data to make educated decisions. Ability to identify critical issues and exercise independent judgment. Proficient in the use of Microsoft programs; Excel and Word. Salary $open. (DC10318)