Integrated ADM Specialist

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider – encompassing physical, mental and financial health – TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider – encompassing physical, mental and financial health – TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

Responsibilities:  

• Our team and what we’ll accomplish togetherThe Integrated ADM Specialist serves as the primary subject matter expert and facilitator for the  Americans with Disabilities Act (ADA) interactive process as well as the Pregnancy Workers Fairness Act (PWFA) in addition to overseeing, managing, processing, and adjudicating FMLA, State, and company specific leaves, as well as straightforward and complex STD claims; to determine benefits due pursuant to an STD plan: and to ensure the ongoing processing of claims.   
   Must analyze reported Family Medical Leave (FMLA) requests; to make determinations based on Federal and State regulations; to communicate clearly with clients and claimants on all aspects of the claims process; and to ensure that claim management processes are followed per our best practices and client specific steps.  
   With respect to the ADA and PWFA, this role is responsible for guiding employees and clients  through the reasonable accommodation process, mitigating legal risk, and ensuring  a seamless integration between short-term disability (STD), FMLA/leaves, and  ADA requirements

• What you’ll do
  • Manage and process FMLA (and other Federal leaves as applicable) Military leaves, State leaves, company specific and STD claims. With regard to FMLA, will manage all DOL category claims; including re-certifications and the 2nd and 3rd opinion processes. 
  • Manage all ADA and PWFA claims by advising clients on options for reasonable accommodation and making recommendations regarding the best approach for managing such claims as it relates to the ADA and PWFA.  
  • Conduct case assessments, contacting the employee and their manager / HR by telephone or email, to explain the leave management process, employee accountabilities, and gather information for assessment purposes.   
  • Develop and document an understanding of the situation and the factors supporting, as well as inhibiting, a successful return to work for the employee against the essential job functions and undue hardships for the client organization.  
  • Review all relevant information and consult with appropriate medical resources as required (nurse consultants, health professionals, supervisory team) to confirm decision and recommendations on FMLA, State, Company specific leaves, STD and ADA cases.  
  • Analyzes FMLA medical certifications and other medical documentation and ensures claim determination adheres to the required regulatory compliance timeframes.  
  • Informs STD claimants of any documentation needed to process a claim, timeframe requirements, claim’s status (e.g. STD approvals, denials, and consults), or any other information necessary to manage a claim.   
  • Determine an appropriate RTW goal with the employee and the employer; as well as, provide active support for the return-to work planning process between the employee and their supervisor and intervene when necessary.   
  • Act as the primary case contact and will communicate proactively and continuously with the employer’s representative(s) regarding any case management matters that may be required through the life of claim.    
  • Will follow all processes as laid out in the operating procedures and/or as detailed in trainings/meetings.  
  • Attend Case Management and Disability Management department team meetings and trainings as required.   
  • Other projects and tasks as assigned.

• What you bring
  • Minimum 5+ years of direct experience managing Leaves, STD and ADA / PWFA claims or high-level disability case management. 

• • Computer skills and the ability to work primarily online in a paperless environment.  

• • Strong interpersonal and helping skills along with assessment and problem-solving skills. 

• • Regulatory Expertise: Deep understanding of the Americans with Disabilities Act  (ADA), Pregnancy Workers Fairness Act (PWFA), FMLA, and state-specific leave laws.  

• • Company policies and plans: experiencing in managing self insured Short Term Disability (STD) Plans as well as company specific paid and unpaid leave policies.
  • Medical Literacy: Ability to review and interpret medical documentation and  translate clinical restrictions against essential job functions and make recommendations related to workplace accommodations.  

• • Communication: Exceptional conflict resolution and negotiation skills, with the ability to handle sensitive medical information with extreme confidentiality and empathy. 

• • Key Collaborative Relationships with
    • US Disability Case Managers: To ensure a seamless transition from leave / STD to accommodation.
    • Medical Providers: Regular interaction with nurses and physicians to validate functional  capacities. 
    • Client contacts: Collaborating with client-side leadership on a continual basis via telephone, email and meetings, as needed.  
    • Service Delivery Managers: Maintaining constant communication to ensure client satisfaction  and operational efficiency. 

Working Conditions

• Environment: Primarily a professional remote environment.
• Physical Demand: Sedentary. High volume of telephonic and computer-based work 
• Mental Demand: Requires a high degree of emotional intelligence and the ability to manage stressful situations involving employee health and legal compliance.

A bit about us

We’re a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world. 

TELUS Health is an Equal Opportunity Employer that aims to foster an inclusive culture that embraces diversity. It is our policy to hire without regard to race, color, creed, religion, national origin, citizenship status, sex, marital status, age, disability, sexual orientation or veteran status.We offer accommodation for applicants with disabilities, as required, during the recruitment process. 

By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies’ Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.