Position Summary

ADA Specialists/ ADA Consultant partner with the employee and employer to gather and communicate the facts about the accommodation need/request, substantiate the medical need for an accommodation, evaluate accommodation options/costs (including alternative options), & manage documentation and supporting material.

Job Responsibilities

Basic Function

- Administer ADA (Americans with Disability Act) standalone claims
- Complete eligibility decisions and review for entitlement, gather pertinent data when necessary, from employee, physicians office or employer through outgoing calls, email, fax or other supporting systems.
- Promptly review new ADA, evaluate against appropriate leave plans and make initial claim decision.
- Perform leave administration tasks as required, including recertification of health condition, intermittent claim tracking, RTW confirmation, return phone calls, etc.
- Update systems to accurately reflect leave status and ensure appropriate diary documentation exists
- Business recommended TAT to complete the activity is up to 5 business days to maintain compliance measures
- The position is expected to do absence management and adjudication on Federal, State and company leaves.
- Interact with claim specialist, claim support specialist, QA, Claims Unit Leader (stateside supervisors), employees, employers/customer and physician’s office

Essential Functions

- Analyze, validate and process transactions as per Desktop procedures (L3 & L4)
- Analyze and research all discrepancies
- Research & Investigate and resolve outstanding items
- Determine eligibility, entitlement and applicable plan provisions while meeting timeliness goals
- Clear and accurate written and verbal communication (Mix of scripted/unscripted) with employee, employer & stateside resources by email and outgoing calls
- Establish action plans for each file to bring claims to resolution
- Utilize internal and external specialty resources to maximize impact on each claim file




- Use PC programs to increase productivity and performance
- Ensure that the assigned targets are met in accordance with SLA, Performance Guarantee and Internal standards
- Ensure that the quality of transaction is in compliance with predefined parameters as defined by Process Excellence
- Work as a team member to meet office goals to obtain disability’s vision while demonstrating core values and meeting key measures
- Ensure adherence to established attendance schedules
- Close visual activity - viewing a computer terminal and extensive reading

Any other essential function that may occur from time to time as directed by the Supervisor.

Primary Internal Interactions

- UM for the purpose of reporting performance, escalation handling, clarifying concerns, and seeking feedback and support
- Manager for the purpose of settling issues left unresolved by the AM and monthly evaluation of performance
- Subject Matter Expert for the purpose of work thread related issues and escalated transactions
- QCA for the purpose of feedback and internal Performance Guarantee quality audit team
- Trainers for the purpose of Pre-process and Process DCA training
- Disability Customer Advocates for escalation resolution

Primary External Interactions

- End customer to be contacted through emails/calls for information gathering/decision update
- Claims specialist & other Stateside Teams on emails/calls
- SME / Trainers at the client end for training

Education, Technical Skills & Other Critical Requirement

Education

Bachelor’s degree (Any Stream) or diploma with a minimum of 15 years of education.

Experience

(In Years)

Minimum 3-4 years of experience in customer service background of insurance or related industry with relevant experience of working in a business environment (preferred but not compulsory)

Technical Skills

- Good computer navigation skills
- Valuable keyboarding speed
- Good knowledge of complete MS Office suite

Process Specific Skills

- Knowledge about the Insurance industry in US
- Knowledge about US Culture
- Knowledge of Insurance principles

📌 Team Leader - Operations (Noida)
🏢 MetLife
📍 Noida