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.

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Job Summary

The 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 Responsibilities

Claims Administration & Case Management

• Manage 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) claims
• Review claims for eligibility, completeness, and compliance with plan provisions and regulatory requirements
• Evaluate medical documentation to determine claim approval, denial, or continuation
• Track claim durations, return-to-work dates, and recertification requirements
• Maintain accurate and up-to-date case documentation in claims management systems

Regulatory Compliance

• Ensure compliance with all applicable laws and regulations, including FMLA, ADA, state leave laws, ERISA, and HIPAA
• Apply plan rules consistently and in accordance with governing documents
• Identify potential accommodations and engage in the interactive process where applicable

Communication & Customer Service

• Act as the primary point of contact for employees, employers, healthcare providers, and vendors
• Clearly explain claim decisions, benefit entitlements, and employee responsibilities
• Respond to inquiries via phone/email/written correspondence within service-level agreements
• Deliver difficult claim outcomes with professionalism, empathy, and accuracy
• Coordinate with medical professionals to obtain necessary documentation
• Escalate complex or high-risk cases to management as appropriate

Quality, Reporting & Continuous Improvement

• Meet productivity, accuracy, and compliance metrics
• Participate in audits, quality reviews, and process improvement initiatives
• Stay current on regulatory changes and internal policy updates

Required Qualifications

• Bachelor's degree
• 2-5 years of experience in leave administration, disability claims etc
• Working knowledge of FMLA, disability plans, and absence management processes
• Strong analytical and decision-making skills
• Excellent written and verbal communication skills
• Proficiency with Microsoft Office tools

Key Competencies

• Attention to detail and strong organizational skills
• Ability to handle sensitive information confidentially
• Strong customer focus and empathy
• Time management skills with the ability to handle multiple cases simultaneously
• Ability to interpret medical and legal documentation