Absence Management Specialist II

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life-changing medicine.

To continue our tradition of excellence, we are in search of an Associate Absence Management Specialist II to join this community as well. This role may work remotely. 

The Absence Management Specialist II analyzes assigned claims to determine whether the case is medically supported for both leave and disability benefits. The Absence Management Specialist II is responsible for the ongoing management of claims within set parameters as well as medical consultation with treating providers and referrals within the guidelines of the program. Services include employee and manager counseling on all absence policies to include disability benefits, FMLA, state sponsored leaves and employer sponsored leave benefits. Provide support to HRBP, employees and manager during the lifecycle of the absence. The Absence Specialist II provides training support during onboarding and assists with questions and mentoring as employees grow with the organization.

Responsibilities:
 

• Assist Supervisor in the analysis of absence patterns and issues to be reviewed and addressed with the client. Provide recommendations to improve identified issues or address opportunities to improve absence patterns.
• Provide mentoring support to peers when dealing with challenging absence issues such as extended time away from work, complex medical diagnoses and recertification issues.
• Assist in the generation of reports for absence team such as ToDos, open case lists and productivity reviews.
• Assists in the identification of recommendations to positively impact the efficiency and quality of service delivery.
• Provide subject matter expertise through classroom training, one-on-one discussion or written documentation regarding systems, processes and procedures relating to all aspects of absence management.
• Participate in and develop on demand client trainings to facilitate ongoing understanding and knowledge of the regulations and client specific policies.
• Utilizes payroll system [Kronos] and web-based vendor software as needed to input and update claim data and generate reports.
• Support partnership with vocational team to ensure proactive claims management plans are set and established return to work and stay at work processes are followed.
• Utilizes Clinical nurse Case Manager and/or Medical Director resources within established guidelines.
• Coordinates the absence process; make claim determinations to include eligibility review, timely notification, and follow-up, employee understanding, accurate documentation, appropriate referrals, coordinate appropriate benefits and maximum duration thereof. Support the return-to-work process.
• Advises employees, employee's family members, managers and HR Professionals on absence policies and processes. Supports in-bound and outbound employee absence-related calls.
• Apply concepts and rules as mandated by guidelines for FMLA, ERISA and other federally or state mandated or company specific policies.
• Track employee absences as reported via web, fax, phone and e-mail.