Mutual of Omaha · 20 hours ago
PFML - FMLA Leave Claims Specialist
United States
Full-time
Remote
Entry, Mid, Senior Level
$25/hr - $26/hrMutual of Omaha is a company specializing in Paid Family & Medical Leave and absence-related programs. They are seeking a PFML - FMLA Leave Claims Specialist to evaluate claims, ensure compliance with regulations, and provide excellent customer service while managing claims processes.
Auto InsuranceCommercial InsuranceFinancial ServicesHealth InsuranceInsuranceLife InsuranceProperty Insurance
No H1B
Responsibilities
Makes sound recommendations and works towards independent decision-making by thoroughly evaluating claims and gathering necessary information to formulate action plans
Develops files that demonstrate appropriate decision-making based on claim facts, policy provisions, state regulations, and customer expectations, ensuring all actions and rationales are well-documented
Establishes and maintains professional relationships with claimants, brokers, sales organizations, vendor partners, employers, and internal partners, ensuring communication aligns with Mutual of Omaha's values
Accurately determines financial liability based on various factors and manages claims with limited autonomy to approve payments, ensuring timely and accurate claims processing
Adheres to federal and state laws for group disability insurance, stays updated on industry changes, and consistently provides high-level customer service, including clear written explanations to claimants
Qualification
Required
Makes sound recommendations and works towards independent decision-making by thoroughly evaluating claims and gathering necessary information to formulate action plans
Develops files that demonstrate appropriate decision-making based on claim facts, policy provisions, state regulations, and customer expectations, ensuring all actions and rationales are well-documented
Establishes and maintains professional relationships with claimants, brokers, sales organizations, vendor partners, employers, and internal partners, ensuring communication aligns with Mutual of Omaha's values
Accurately determines financial liability based on various factors and manages claims with limited autonomy to approve payments, ensuring timely and accurate claims processing
Adheres to federal and state laws for group disability insurance, stays updated on industry changes, and consistently provides high-level customer service, including clear written explanations to claimants
Develops understanding of complex insurance provisions and contracts, and applies insurance regulations to claim situations
Analyzes and interprets vocational and medical information for claims decisions, calculates benefits based on contract provisions, and demonstrates strong analytical and decision-making skills
Manages tasks efficiently using multiple systems, meets deadlines, and transitions from dependent to independent decision-making
Communicates professionally with high customer service standards, both written and verbal, and effectively diffuses situations and escalates when necessary
Proficient in personal computers, Microsoft applications, and Mutual of Omaha systems, with strong organizational skills, attention to detail, adaptability to change, and the ability to manage ongoing claims for multi-year durations
You promote a culture of diversity and inclusion, value different ideas and opinions, and listen courageously, remaining curious in all that you do
Able to work remotely with access to a high-speed internet connection and located in the United States or Puerto Rico
Preferred
Disability experience
PFML, FMLA experience
Leave Absence Management experience
Benefits
401(k) plan with a 2% company contribution and 6% company match.
Work-life balance with vacation, personal time and paid holidays.
Company
Mutual of Omaha
Mutual Of Omaha is a mutual insurance and financial services company helping clients achieve their financial goals.
Founded in 1909
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
David A. Diamond
EVP, CFO and Treasurer (Retired)
Brian Poppe
SVP, Income and Wealth Planning
Recent News
2025-12-24
2025-11-15
Company data provided by crunchbase