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PLADS Sr Life Claim Analyst

The Company:  Aflac Columbus
The Location: 

Remote, US Farmington, CT, US, 06032

The Division:  PLADS
Job Id:  1692

Job Summary

Handles a complex case load of Life and Accidental death claims. Makes timely, accurate, and customer[1]focused claim decisions. Serves as resource and mentor for other team members. Proactively engages legal, compliance, employer, and other informational internal and external sources to gather relevant data, and compares it to the applicable contract and procedures. 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 Life and Accident new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards; handles the most complex claims; reaches out to obtain relevant medical and police, legal, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract 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

 

Education & Experience Required

Bachelor's Degree in a related field

 

3 - 5 years of Life industry claims experience

 

Demonstrated proficiency in product specific areas of Life or Disability as well as federal and state regulations governing these products and services

 

Or an equivalent combination of education and experience.

 

Job Knowledge & Skills

• Strong familiarity with claim management concepts

 

• Strong understanding of medical terminology/pathology/anatomy

 

• Articulate verbal and writing skills, decision making, meeting deadlines, working with  confidential information

 

• Strong skills with Microsoft Office and other software applications

 

• Customer service skills

 

• Stress tolerance

 

• Ability to multi-task and prioritize

 

• High level of attention to detail

 

• Can work under pressure

 

• Confidence to make claim decisions

 

• Results-driven

 

• High attention to departmental/company procedures/practices

 

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