Sr STD Case Manager Job at Aflac (Farmington)

Job Responsibility

Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards
handles the most complex claims from a clinical and financial perspective
reaches out to obtain relevant clinical, vocational, employer, financial, and other information
compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible
Documents the claims system in an accurate and comprehensive manner
prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome
remains in full compliance with regulatory requirements
demonstrates an above average level of proficiency in product and claims administration techniques
remains fully compliant with operational standards
meets or exceeds claims team operational metrics
Maintains a superior level of genuine caring and empathetic customer service throughout all interactions
takes appropriate actions to earn the claimant's and employer's trust and confidence
anticipates customer’s needs and takes action as appropriate
Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence
Mentors and coaches new team members and participates in projects supporting the team's business initiatives
Performs other related duties as required

Requirements

High School Diploma or equivalent
3 - 5 years of STD Industry claims management experience
Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services
Or an equivalent combination of education and experience
Bachelor's Degree In healthcare or a related field

What we offer

medical
dental
vision coverage
prescription drug coverage
health care flexible spending
dependent care flexible spending
Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee)
401(k) plans
annual bonuses
an opportunity to purchase company stock
11 paid holidays
up to 20 days PTO to be used for any reason
state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked)
other leaves of absence

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Sr STD Case Manager

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