Absence Case Specialist

Absence Case Specialist

Location: Wellesley Hills, Massachusetts Country: United States Category: Business Analyst Workplace

Location

Remote Employment Type: Contract Posted Date: September 28, 2026 Job ID: 652447

Job Title: Absence Case Specialist Number of Positions: 6 Contract: 6 months Site/Location: Remote working EST hours Pay: 23-28.99/hr, depending on experience

Job Details

The Absence Case Specialist will be responsible for managing routine claims where duration guidelines and/or Clinical resources will assist in determining benefit periods.

Absence Case Specialist Requirements:

• 1-2 years of customer / financial services experience
• Bachelor’s degree preferred but not required
• Effective ability to use legal resources and demonstrate a proven ability to comprehend and interpret legal and medical terminology in order to make final decisions to approve or further investigate claims
• Demonstration of strong mathematical skills for calculations and adjustment of claim payments
• Strong computer skills, proficient in PC environment and MS Word, Excel, and email systems
• Excellent Disability and Absence Management knowledge with demonstrated expertise in Federal/State FMLA, short-term disability, statutory disability plans, and ADA
• Communicate effectively and professionally with a wide variety of both internal and external business partners, peers and resources
• Attention to detail with documentation, reporting and communication
• Facilitation skills in a variety of circumstances and with a wide variety of input
• Healthcare, insurance, TPA, employer leave administration, or carrier experience preferred
• Claims background, medical terminology preferred
• Ability to influence and teach
• Self-directed with an ability to work independently and make independent judgments and decisions
• Strong organizational skills, including the ability to prioritize work and multi-task.
• Strong research, analytical, critical thinking, problem solving skills and decision-making skills
• Ability and desire to work in a fast-paced, service-oriented environment
• Excellent verbal communication skills, with the ability to be both pleasant and professional
• Strong written communication skills
• Strong interpersonal and customer service skills
• Ability to initiate and prioritize regular work duties and projects
• Detail oriented, organized, the ability to multi-task, and strong time management skills
• Ability to work professionally and effectively with co-workers, clients, claimants, vendors and others with whom the client does business
• Ability to stand, move from one room to another, and frequently sit
• Ability to understand the spoken word, written word, both hard-copy and on-line and must be able to respond in kind
• Ability to operate standard business equipment including a computer and a variety of software applications

Absence Case Specialist Responsibilities:

• Work with employers, employees and health care providers to administer an integrated Family and Medical Leave Act (FMLA) rights and responsibilities and Short Term Disability claim
• Provide advice and counsel regarding leave administration and effectively coordinate all cases/claims in compliance with the FMLA and all related employment laws
• Responsible for the professional management of both routine and complex claims for Group Short Term Disability while working both independently and in a team to ensure superior service to policyholders and claimants
• Review claims and make final determination for admittance or denial
• Approve payment of claims and Company liability within established limits
• Work within a team environment among a peer group and business partners with related subject matter expertise to service client needs related to absence, disability and accommodations
• Interpret and administer leave programs and policies in accordance with the applicable federal and state employment laws (FMLA, ADA, USERRA, Pregnancy Discrimination Act, etc.)
• Facilitate and engage in interactive dialogue with employees, medical professionals, supervisors, and HR business partners to assist employees
• Documentation of the request for absence including detailed points of contact and actions taken to coordinate the accommodation request
• Review claim payments within established limits and/or reviews recommendations made by medical resources to determine proper disposition of claims
• Set claim action plan to ensure that determinations are adjudicated in a timely, accurate, and efficient manner
• Interpret contracts and ensure consistent, fair claims practices and adherence to appropriate laws, regulations, and procedures
• Obtain backup documentation, as necessary, to substantiate claim or to provide service by communicating via telephone with agents, employers (policyholders), claimants, hospitals, physicians, attorneys, and other resources
• May handle other related duties such as providing technical assistance to other Claims staff or assisting in special projects or assignments as a result of business needs
• Protect and maintain personal health information with a high level of confidentiality abiding by the client's procedures and by HIPPA rules and regulations
• Other duties and responsibilities as assigned

EEO Statement The staffing industry has seen an increase in people falsely representing themselves as recruiters to gather personal information from job seekers. For your safety, do not provide sensitive data to anyone you have not spoken with thoroughly, never provide banking information during the application process, and always double check the email address of the Recruiter to ensure it’s from an official Planet domain and not a domain with an alternative extension like .net, .org, or .jobs.

The Planet Group and our companies are equal opportunity employers. It is our practice not to discriminate against any employee or applicant based on any criteria, condition or basis protected by laws or regulations in the locations where we do business. All qualified applicants are encouraged to apply. We celebrate diversity and are committed to providing an environment of mutual respect. We believe that diversity, equity, and inclusion enable us to better meet our mission and values while serving our clients across the globe. If you have a disability or handicap and would like us to accommodate you in any reasonable way, please inform your recruiter, or contact us, so that we can discuss the appropriate alternatives available.