PFML- Absence Management Claims Consultant
$98,010–$119,790 year
On-siteOmaha, Nebraska, United States
Job Summary
Design and build the future-state Paid Family and Medical Leave (PFML) claims operation by partnering with Product, Technology, Legal, and Operations teams to define business requirements, develop workflows, and create training materials. Act as the PFML subject matter expert throughout the product development lifecycle, including requirements gathering, solution design, testing, and implementation. Administer and adjudicate PFML claims from intake through resolution, interpreting state-specific eligibility requirements and benefit calculations while ensuring timely, accurate, and compliant decisions. Monitor evolving state PFML legislation to translate regulatory requirements into scalable operational solutions and recommend innovative solutions to improve customer experience and operational efficiency.
Required Qualifications
- 5+ years of experience in Paid Family and Medical Leave (PFML), disability claims, leave management, absence management, insurance claims, or a related field
- Strong knowledge of state PFML programs, leave laws, regulatory requirements, and employer-sponsored leave and disability products
- Experience interpreting statutes, regulations, policy provisions, administrative guidelines, and complex business requirements
- Demonstrated ability to make fair, balanced, and objective decisions with a high degree of integrity and professionalism
- Strong analytical, investigative, problem-solving, and critical-thinking skills
- Excellent verbal and written communication skills, with the ability to effectively communicate with customers, employers, brokers, and internal partners
- Customer-focused with a compassionate and empathetic approach to helping employees navigate significant life events
- Strong organizational and time-management skills with the ability to manage multiple priorities in a fast-paced environment
- Ability to work independently while collaborating effectively with cross-functional teams, including Product, Technology, Legal, Compliance, Operations, and Customer Service
- Experience supporting process improvement initiatives, workflow design, procedure development, training, quality assurance, testing, or system implementation activities
- Detail-oriented with the ability to learn and become proficient in claims administration systems, workflow tools, reporting platforms, and related technologies
Desired Qualifications
- College degree or equivalent work experience preferred
- Insurance designations, industry certifications, and experience with FMLA, ADA, Disability, or integrated absence management programs are preferred
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