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?
Psychiatric experience/knowledge
Solid investigative and analytical skills
Solid customer service skills
Solid written and oral communication skills
Solid organizational and time management skills
Ability to analyze behavioral health records in the context of functional capacity
Work in team environment
Business Travel, as required
Extended Hours during Peak Periods, as required
Maintain a Valid Driver's License, as required
Pass Applicable Exam/Licensing, and maintain active license as required
Regular Predictable Attendance
Model behaviors that demonstrate commitment to corporate values
Provide input into performance management discussions of project team members, if requested by manager
Educate team members and business partners on area of clinical expertise
Provide guidance and support for team members
Manage own personal development and encourage others to do the same which includes promoting a healthy and positive work environment
Seeks and maintains current profession credentials
Education & Experience Required
Bachelor’s Degree in healthcare or a related field
A minimum of 3 years of experience in the field of behavioral health working with behavioral health patients
Current license and or License eligible
Or an equivalent combination of education and experience
Education & Experience Preferred
Master’s Degree in Behavioral Health area or in related field, e.g., MSW, MA or MS in counseling
2 or more years of experience in disability management industry managing claims
CDMS or CCM designations
Utilization Review Experience and/or experience using specific behavioral health criteria or protocols
Travel
Less than or equal to 10%
Principal Duties & Responsibilities
Serves as Clinical co-manager on behavioral health claims from day 1 of STD claims and provides activities requiring clinical expertise including, but not limited to, performing provider interviews, analyzing clinical information submitted, and negotiating return to work plans with employee, treating provider, and employer if applicable
Reviews and evaluates disability claims to determine level of functioning based on knowledge of behavioral health conditions and knowledge of the employer and the employee's job requirements, as well as the plan's definition of disability
Investigates and resolves inconsistencies in the level of cognitive, emotional, or behavioral functioning
Coordinates a strategy to determine true level of functional capacity utilizing direct contact with the treating provider and/or utilizing internal clinical resources (e.g. Peer-to-Peer Reviews, internal impairment guides, round table reviews, etc.)
Reviews claims from a behavioral health perspective to determine if clinical evidence supports preclusion from work or need for accommodation and/or restrictions based on vocational demands per the applicable definition of disability
Documents impairment, functional status, and assessment to include behavioral health, contractual, and vocational information
Acts as behavioral health consultant to the Appeals Unit
Acts as resource for claim and clinical staff when handling claimants noted to be threatening harm to themselves or others
Facilitates referrals to collateral internal and external services, e.g. EAP, disease management programs, Advocacy, etc. as applicable
Monitors response to care and advocates for optimal care if applicable
Coordinates and monitors quality of behavioral health IME's
Coordinates internal physician consultant referrals by using supporting clinical resources and vocational resources
Identifies barriers for employees to return to work as well as identifying appropriate (optimal) health care, rehabilitation, and work to facilitate an appropriate and timely return to work
Communicates effectively with case managers, employers, employees, and health care providers
Strategizes with claimant, treating providers, and employer on possible accommodations or restriction utilization to facilitate return to work
Manages daily relations with assigned accounts and key contacts
Per account requirements and upper management request, visits clients for new account implementation and maintenance of existing accounts
Attends and/or presents clinical lectures designed to educate claim staff as requested.
Independently collates and analyzes data using pre-determined tools, methods and formats and makes recommendations to support the department’s timely resolution of claims
Anticipates, recognizes, and responds timely to needs of customers to ensure customer satisfaction
Supports implementation of customer initiatives to drive best outcomes
Reviews assigned customer cases, prioritizes workload, and interprets established policies, applying discretion within authority limits to resolve customer issues
Provides status updates on co-management plans to ensure clear communications and transparency
Resolves technical problems by referring to policies, procedures, specifications to ensure accuracy and operational consistency
Collects data and prepares clinical reviews including commentary and an analysis to facilitate decisionmaking
Provides detailed procedural advice to internal clients to ensure that internal standards and/or procedures are adhered to related to clinical co-management
Inputs relevant data into established systems accurately to allow for data analysis
Analyzes data using pre-determined tools, methods, and formats; makes recommendations to support the department's timely management of behavioral health claims
Performs additional Job duties as requested by manager
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 $45,000 to $105,000.
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.
