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PLADS LTD Case Manager

The Company:  Aflac Columbus
The Location: 

Remote, US Farmington, CT, US, 06032

The Division:  PLADS
Job Id:  1383

 

Opportunity: PLADS LTD Case Manager 

 

Location(s): CT-Minerva

 

                                                                                                                                                                                                                                                                                                                      

Job Summary

Makes timely, accurate, and customer-focused Long-Term Disability claim decisions. Proactively engages clinical, vocational, employer, financial, and other informational internal and external sources to gather relevant data, and compares it to the applicable contract/administrative agreement and procedural documents. Conducts an analysis of data and engages peers and management as appropriate. Communicates verbally and in writing an accurate and comprehensive decision. Maintains performance

at or above departmental metrics.

 

Principal Duties & Responsibilities

  • Makes timely, accurate, and customer-focused Long-Term Disability, new and ongoing claim decisions on a mixed degree of complex claims; 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

 

  • Performs other related duties as required

 

Education & Experience

High School Diploma and 5 years of LTD industry claims experience, or an equivalent combination of education and experience.

 

Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services (Required)

 

1+ years of Supervisory, Managerial, and/or leadership experience (Preferred)

 

Utilization Review Experience and/or experience using specific medical and/or behavioral health criteria or protocols (Preferred)

 

2 or more years of experience in disability management industry managing claims (Preferred)

 

Master’s Degree (Preferred)

 

Bachelor's Degree in business, healthcare, or a related field (Preferred)

 

 

Job Knowledge & Skills

  • Strong understanding of disability claim 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

 

  • Proven ability to multi-task

 

Competencies

  • Acting with Integrity - Clearly states goals and beliefs; lets people know his/her true intentions; does what he she said they would do; follows through on commitments

 

  • Communicating Effectively - Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener

 

  • Pursuing Self-Development - Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities

 

  • Serving Customers - Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages

 

  • Supporting Change - Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial

 

  • Supporting Organizational Goals - Actively supports organizational goals and values; demonstrates enthusiasm toward the company's goals and mission; aligns actions around organizational goals

 

  • Working with Diverse Populations - Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds

 


Nearest Major Market: Eugene