Case Verification Manager

The Company:  CAIC PFML
The Location: 

Windsor, CT, US, 06095

The Division:  PLADS
Job Id:  7164

Salary Range: $31,200 - $71,000

Job Posting End Date: December 31, 2024

 

We’ve Got You Under Our Wing

We are the duck. We develop and empower our people, cultivate relationships, give back to our community, and celebrate every success along the way. We do it all…The Aflac Way.

 

Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands. Aflac has been recognized as Fortune’s 50 Best Workplaces for Diversity and as one of World’s Most Ethical Companies by Ethisphere.com.

 

Our business is about being there for people in need. So, ask yourself, are you the duck? If so, there’s a home, and a flourishing career for you at Aflac.

Worker Designation – This role is hybrid. This means you will be expected to report to one of our Aflac offices located in Windsor, CT for at least 60% of the work week. You will work from your home (within the continental US) for the remaining portion of the work week. Details of this schedule will be discussed with your leadership. 

 

What does it take to be successful at Aflac?

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

 

What does it take to be successful in this role?

• Knowledge and skills in Microsoft Office.

 

• Knowledge of Aflac/PLADS systems, products and procedures, company terminology.

 

• Knowledge of business operations and industry.

 

• Excellent oral, written, and interpersonal communication skills to effectively interact with internal and external customers. 

 

• Ability to maintain professionalism.

 

• Ability to successfully work independently or with a team.

 

• Excellent attention to detail to ensure accuracy of data.

 

• Ability to meet deadlines.

 

Education & Experience Required

  • High School Diploma or Equivalent
  • Three years of job related experience

Or an equivalent combination of education and experience

 

Principal Duties & Responsibilities

• Review, investigate, and maintain internal red flag control reports. Identify, report, and resolve any confirmed instances of misrepresentation.

 

• Review and investigate claims for potential misrepresentation that are referred from internal or external sources. 

 

• Identify trends in red flags and instances of confirmed misrepresentation to enhance our controls.

 

• Refer all suspicious claims to SIU for official investigation, and review final reports to evaluate for areas of improvement.

 

• Maintain reporting and tracking of confirmed falsified claims and any financial losses, to ensure they are identified to all appropriate business partners; CT Authority, Aflac privacy, SIU, Accounting, etc.

 

• Serve as the point of contact for incoming and outgoing communication relating to suspicious or confirmed misrep claims. 

 

• Offer continuous education to case managers to enhance their ability to identify, understand, and investigate potential red flags and instances of misrepresentation.

 

Total Rewards

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. The range has been created in good faith based on information known to Aflac at the time of the posting.  Compensation decisions are dependent on the circumstances of each case. This salary range does not include any potential incentive pay or benefits, however, such information will be provided separately when appropriate. The salary range for this position is $31,200 to $71,000.

 

In addition to the base salary, we offer an array of benefits to meet your needs including medical, dental, and 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, and an opportunity to purchase company stock.  On an annual basis, you’ll also be offered 11 paid holidays, up to 20 days PTO to be used for any reason, and, if eligible, state mandated sick leave (Washington employees accrue 1 hour sick leave for every 40 hours worked) and other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being. Aflac complies with all applicable leave laws, including, but not limited to sick and safe leave, and adoption and parental leave, in all states and localities.


Nearest Major Market: Hartford