US health Leave of Absence/Short Term Disability Claims– Team Lead - Gurugram

Location: Gurgaon • Experience: Senior Level • Openings: 3

Job description

Job Title: US health Leave of Absence/Short Term Disability Claims– Team Lead

Requirements:

Bachelor’s degree from an accredited university or college.

Minimum 4 - 8 years of experience in disability claims, insurance claims, or FMLA/PFL leave management.

Strong working knowledge of medical terminology and documentation, including APS, diagnostic tests, and imaging reports.

Solid understanding of disability insurance processes, including benefits administration, offsets, deductions, and claim duration.

Experience in case/claims management with the ability to assess, review, and process cases accurately.

Excellent verbal and written communication skills, including the ability to present information clearly and effectively.

Strong analytical, problem-solving, and decision-making abilities in a fast-paced environment.

Ability to identify and manage escalated cases, collaborating with team leaders to resolve complex issues.

Effective priority-setting skills, focusing on high-impact tasks and managing time efficiently.

Strong interpersonal and people management skills with the ability to work collaboratively.

Customer-centric mindset with a commitment to delivering high-quality service and exceeding expectations.

Ability to communicate empathetically and assertively with internal and external stakeholders.

Proficiency in MS Office tools, including Excel, Word, and PowerPoint, along with strong keyboarding skills.

Adaptability and willingness to embrace change in a dynamic work environment.

Continuous learning mindset with a focus on self-improvement and process enhancement opportunities.

Candidate Specification& Job Responsibilities

Managed end-to-end disability and absence claims, including intake, adjudication, and closure based on medical documentation and policy guidelines.

Reviewed and analyzed medical records (diagnostic tests, physician statements, operative reports) to determine disability status.

Assessed eligibility for Short-Term Disability (STD), FMLA, and Paid Family Leave in accordance with employer and regulatory requirements.

Evaluated both intermittent and continuous leave claims, ensuring proper classification and tracking.

Interpreted disability plans and leave policies to make accurate claim approval or denial decisions.

Calculated and processed benefits, ensuring timely payments, approvals, and necessary adjustments.

Applied offsets such as Workers’ Compensation and State Disability benefits during claim calculations.

Identified and resolved Not-in-Good-Order (NIGO) cases by securing required documentation.

Conducted proactive outreach to claimants, healthcare providers, and employers for missing or incomplete information.

Collaborated with clinical and vocational teams to validate medical findings and support return-to-work initiatives.

Utilized clinical guidelines and internal resources to assess claim duration and recovery timelines.

Communicated claim decisions, requirements, and next steps clearly via phone and written correspondence.

Managed high-volume caseloads while meeting service level agreements (SLAs) and turnaround timelines.

Handled first-level and second-level escalations, ensuring timely resolution of complex or sensitive cases.

Performed quality assurance checks and participated in peer reviews to maintain accuracy and compliance.

Monitored client deliverables and ensured adherence to contractual and regulatory standards.

Contributed to continuous improvement initiatives, process optimization, and participated in special projects as assigned.