Leave and Disability- US Healthcare

VOYA INDIA Overview VOYA INDIA, formerly known as VFI SLK, is a technology-driven, business process transformation company, driving the evolution of the financial services customer experience through the art of technology, innovation, and human creativity. As a subsidiary of Voya Financial Inc, we are dedicated to delivering cutting-edge solutions to Voya’s Health (employee benefits), Wealth (Retirement) and Investment Management Business. Our focus lies in crafting inventive customer centric solutions by digitizing, automating, and optimizing technology and business processes. We are committed to fostering an environment that celebrates learning, growth and inclusivity while developing and deploying innovative and impactful solutions for Voya Financial Inc. More information is available at : - Job SummaryThe Leave and Disability Claims Processor / Case Manager is responsible for administering employee leave and disability claims in accordance with company policies, plan provisions, and applicable federal, state, and local regulations. This role ensures accurate claim adjudication, timely communication with stakeholders, and a high-quality employee experience while maintaining compliance and confidentiality standards.Key ResponsibilitiesClaims Administration & Case ManagementManage end-to-end administration of leave FMLA (Family and Medical Leave Act) state leaves, company-sponsored leave) and disability (short-term and/or long-term) claimsReview claims for eligibility, completeness, and compliance with plan provisions and regulatory requirementsEvaluate medical documentation to determine claim approval, denial, or continuationTrack claim durations, return-to-work dates, and recertification requirementsMaintain accurate and up-to-date case documentation in claims management systemsRegulatory ComplianceEnsure compliance with all applicable laws and regulations, including FMLA, ADA, state leave laws, ERISA, and HIPAAApply plan rules consistently and in accordance with governing documentsIdentify potential accommodations and engage in the interactive process where applicableCommunication & Customer ServiceAct as the primary point of contact for employees, employers, healthcare providers, and vendorsClearly explain claim decisions, benefit entitlements, and employee responsibilitiesRespond to inquiries via phone/email/written correspondence within service-level agreementsDeliver difficult claim outcomes with professionalism, empathy, and accuracyCoordinate with medical professionals to obtain necessary documentationEscalate complex or high-risk cases to management as appropriateQuality, Reporting & Continuous ImprovementMeet productivity, accuracy, and compliance metricsParticipate in audits, quality reviews, and process improvement initiativesStay current on regulatory changes and internal policy updatesRequired QualificationsBachelor’s degree2–5 years of experience in leave administration, disability claims etcWorking knowledge of FMLA, disability plans, and absence management processesStrong analytical and decision-making skillsExcellent written and verbal communication skillsProficiency with Microsoft Office toolsKey CompetenciesAttention to detail and strong organizational skillsAbility to handle sensitive information confidentiallyStrong customer focus and empathyTime management skills with the ability to handle multiple cases simultaneouslyAbility to interpret medical and legal documentation

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