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Aflac · 20 hours ago

Sr LTD Case Manager

United States

Full-time

Remote

Mid, Senior Level

$65K/yr - $85K/yr

5+ years exp

Aflac is a Fortune 500 company and an industry leader in voluntary insurance products that pay cash directly to policyholders. The Sr LTD Case Manager is responsible for managing Long-Term Disability claims, ensuring compliance with regulatory standards, and providing exceptional customer service throughout the claims process.

FinanceFinancial ServicesHealth CareInsurance

Responsibilities

Makes timely, accurate, and customer-focused Long-Term Disability new and ongoing claim decisions on moderately complex to highly complex claims 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 claim 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 claim 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

Qualification

Disability claims managementMedical terminologyCustomer service skillsMicrosoft OfficeNegotiation skillsAttention to detailIndependent decision makingMulti-taskingWriting skillsEffective communication

Required

Strong understanding of disability claims management concepts

Solid understanding of medical terminology/pathology/anatomy

Ability to verbally articulate clearly, concisely and explain complex situations

Superior writing skills

Confident with independent decision making

Ability to consistently meet deadlines

Proven ability to work with confidential information

Moderate skills with Microsoft Office and other software applications

High level of customer service skills/phone skills

Strong ability to multi-task and prioritize

Must have a high level of attention to detail

Results-driven

High attention to deliver on departmental/company procedures/practices

Ability to work Independently

Strong negotiation skills

High School Diploma or equivalent

5 or more years of LTD industry claims experience

Demonstrated proficiency in product specific areas of STD, LTD or Account Management, and federal and state regulations governing these products and services