Ability Analyst Paid Family Medical Leave

Ability Analyst

We're determined to make a difference and are proud to be an insurance company that goes well beyond coverages and policies. Working here means having every opportunity to achieve your goals – and to help others accomplish theirs, too. Join our team as we help shape the future.

This role requires strong analytical expertise, strategic thinking, and communication skills to accurately adjudicate PFML claims. As an Ability Analyst, you will play a critical role in supporting individuals during some of the most challenging times in their lives. You will be responsible for managing a caseload of PFML claims of moderate complexity, ensuring each claim is handled with empathy, accuracy, and efficiency.

This role requires a balance of analytical thinking, customer service, and regulatory compliance. You will serve as the primary point of contact for claimants, employers, and medical professionals, guiding them through the claims process and ensuring timely and fair outcomes. Your work will directly impact the financial and emotional well-being of our customers.

Ability Specialist for the All Products team supports Paid Family and Medical Leave, Short Term Disability and Leave of Absence. This role requires strong analytical expertise, strategic thinking, and communication skills to accurately adjudicate claims. As Ability Specialist, you will play a critical role in supporting individuals during some of the most challenging times in their lives. You will be responsible for managing a caseload of Paid Family and Medical Leave, Short Term Disability and Leave of Absence claims of high complexity, ensuring each claim is handled with empathy, accuracy, and efficiency.

This role requires a balance of analytical thinking, customer service, and regulatory compliance. You will serve as the primary point of contact for claimants, employers, and medical professionals, guiding them through the claims process and ensuring timely and fair outcomes. Your work will directly impact the financial and emotional well-being of our customers.

Training & Work Arrangements:
All new hires are required to complete a mandatory training program beginning on the start date.

Full attendance is required during this period to ensure successful onboarding and readiness for the role.

This role can have a hybrid or remote work arrangement. Candidates who live near one of our locations will be expected to work in the office 3 days a week (Tuesday through Thursday). Candidates who do not live near an office should maintain their current work arrangement, with the expectation of coming into the office as business needs arise.

Start Date:

October 19th, 2026

Claim Management:

• Independently manage a caseload of PFML claims from intake through resolution.
• Conduct thorough reviews of medical records, employment history, and policy provisions.
• Determine eligibility and benefit entitlement based on contractual language and supporting documentation.

Customer Communication:

• Serve as the main contact for claimants, providing clear, compassionate, and timely updates.
• Communicate with employers, physicians, and legal representatives to gather and clarify information.
• Educate claimants on the PFML process, timelines, and expectations.

Decision-Making & Documentation:

• Make well-reasoned decisions supported by evidence and aligned with policy terms.
• Document all claim activity, rationale, and communications in a clear and professional manner.
• Prepare written correspondence including approval, denial, and status letters.

Collaboration & Escalation:

• Collaborate with internal resources such as peers, CRO, SIU, and Team Leader.
• Escalate complex or high-risk claims to senior team members or management as appropriate.

Compliance & Quality Assurance:

• Ensure all claims are handled in compliance with state regulations, HIPAA, and other applicable requirements.
• Participate in audits, quality reviews, and continuous improvement initiatives.

• Bachelor's degree or equivalent work experience in insurance claims adjudication, healthcare, or a related field preferred.
• THAA experience preferred.
• Ability to understand state regulations,…