PLADS LTD Case Manager II
Location: Remote - US only
Job Type: Full time
Salary Range: $31,200 - $68,000
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 designated as a remote role. You will be expected to work from your home, within the continental US. Although this role is designated as remote, there may be occasions that you are requested to come to the office based on business need. Any requests to come to the office would be communicated with you in advance.
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?
- 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
- Proven ability to multi-task and prioritize
- Must have a high level of attention to detail
- High attention to deliver on departmental/company procedures/practices
- Ability to work Independently
- Strong Negotiation skills
Education & Experience Required
- High School Diploma
- 2- 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
Or an equivalent combination of education and experience
Education & Experience Preferred
- Bachelor’s Degree in Business, Healthcare, or a related field
- Master’s Degree in Business
- 1+ years of Supervisory, Managerial, and/or leadership experience
- Utilization Review Experience and/or experience using specific medical and/or behavioral health criteria or protocols
- 2 or more years of experience in disability management industry managing claims
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
- Performs other related duties as required
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 - $68,000.
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.