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PLADS Sr LTD Case Manager

The Company:  Aflac Columbus
The Location: 

Remote, US, 31999 Farmington, CT, US, 06032

The Division:  PLADS
Job Id:  3702


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 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




Education & Experience Required


  • High School Diploma
  • 5+ years of LTD industry claims experience
  •  Demonstrated proficiency in product specific areas of STD, LTD or AM as well as federal and state regulations governing these products and services


Education & Experience Preferred


  • Bachelor's Degree In business, healthcare, or a related field
  • Master’s Degree in business
  • 2+ years of Supervisory, Managerial, and/or leadership experience
  • Utilization Review Experience and/or experience using specific medical and/or behavioral health criteria or protocols
  • 4 or more years of experience in disability management industry managing claims


Or an equivalent combination of education and experience



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





  • Acting with Integrity 
  • Communicating Effectively 
  • Pursuing Self-Development 
  • Serving Customers 
  • Supporting Change
  • Supporting Organizational Goals 
  • Working with Diverse Populations 

Nearest Major Market: Columbus GA