Clinician Reviewer

Aflac; United States; Remote; USD 80,000 - 95,000; Full time

Job summary

Aflac seeks a remote clinical role responsible for providing expertise on disability claims. Candidates should have extensive healthcare experience and specific knowledge of medical diagnoses. The position offers a salary between $80,000 and $95,000 annually, along with comprehensive benefits to support employee well-being.

Benefits

Medical, dental, and vision coverage

401(k) plans

Annual bonuses

Paid holidays (11 annually)

Up to 20 days PTO

Qualifications

• Extensive clinical experience in health care.
• Knowledge of medical diagnoses and ICD-10 codes.
• Active, unrestricted medical license in the state of residence.

Responsibilities

• Serve as a clinical subject matter expert for disability claims.
• Review and evaluate claims based on knowledge of health conditions.
• Communicate with stakeholders to ensure customer satisfaction.

Skills

Analytical skills

Customer service

Communication

Organizational skills

Investigative skills

Teamwork

Education

Associates Degree or Nursing Diploma

Bachelor's Degree in healthcare or related field

Job description

Salary Range: $80,000 - $95,000

Job Posting End Date: June 25th 2025

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 a remote role. This means you will be expected to work from your home, within the continental US. If the role is 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?

• Extensive clinical experience/knowledge.

• Knowledge of medical diagnoses and ICD-10 codes.

• Strong investigative and analytical skills.

• Strong customer service and advocacy skills.

• Strong written and oral communication skills.

• Strong organizational and time management skills.

• Ability to analyze health care records in the context of functional capacity.

• Strong desire and ability to work in a team environment.

• Flexibility and coachability in the context of organizational growth and process change and development.

• Demonstrated ability to prioritize workload in a fast-paced environment, with proven organization and time management skills.

Education & Experience Required

• Associates Degree or Nursing Diploma
• Three years of experience in the field of health care working directly with patients.
• Two or more years of experience in absence management industry managing disability claims.
• Active, unrestricted medical license in the state of residence.

Or an equivalent combination of education and experience

Education & Experience Preferred

• Bachelor's Degree In healthcare or related field.

Travel

Less than or equal to 10%

Principal Duties & Responsibilities

• Serves as a clinical subject matter expert to disability case managers and provides well-reasoned and timely clinical analyses related to functional impairment.

• Reviews and evaluates disability claims to determine level of functioning based on knowledge of co-morbid health conditions. • Investigates and resolves inconsistencies in the level of functioning.

• Through a clinical advocacy approach, the clinician partners with case managers on return-towork plans via contacts with treating providers and employees when applicable.

• Assists in investigating and resolving inconsistencies in the level of employee functionality related to treating provider opinions, and projections of incapacity and impairment.

• Coordinates strategies to determine levels of employee functional capacity, utilizing direct contact with treating providers, and/or utilizing internal clinical resources (e.g. medical guidelines, independent medial reviews, internal impairment guides, claim discussion meetings, reviews).

• Acts as a clinical consultant and resource to the Appeals department when applicable and attends meetings as needed.

• Provides continuing education for case management staff via mini-clinical lectures, and assists in the development of clinical tools, guides, training, templates, processes, and protocols.

• Attends and/or presents clinical lectures designed to educate claims staff as requested.

• Facilitates referrals to ancillary internal and external services, e.g. EAP, disease management programs, advocacy, care managers, etc. as applicable.

• Identifies barriers in returning to work, to include identifying and prompting optimal health care to facilitate an appropriate and timely return-to-work plan and strategy.

• Communicates effectively with case managers, employers, employees, and health care providers.

• 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 processes and guides to resolve customer issues.

• Provides status updates to case managers to ensure clear communications and transparency.

• Resolves technical problems by referring to policies, procedures, and specifications, to ensure accuracy and operational consistency.

• Collects data and prepares clinical reviews, including commentary and an analysis to facilitate decision-making.

• Inputs relevant data into established systems accurately to allow for data analysis.

• Performs other related duties as required.

Total Rewards

The salary range for this job is $80,000 to $90,000. This range is specific to the job and salary offers consider a wide range of factors that are considered in making compensation decisions, including, but not limited to: education, experience, licensure, certifications, geographic location, and peer compensation. The range has been created in good faith based on information known to Aflac at the time of the posting.

At Aflac, it is not typical for an individual to be hired at or near the top of the range for the role to allow for future and continued salary growth, and 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.

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.