Remote Review Services Leader

Comunidade Metodista

United States

Remote

USD 110,000 - 125,000

Full time

14 days+

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Job summary

Aflac, a Fortune 500 leader in voluntary insurance, is seeking a qualified professional for a remote role in the U.S. You will support disability and absence claims, manage complex customer cases, and mentor团队 members while ensuring regulatory and policy compliance.

Responsibilities include analyzing documentation, guiding referrals, and collaborating with internal partners to drive outcomes. Bachelor level health-related education and active licensure are required, with advanced degrees

Qualifications

In-depth clinical, vocational, behavioral health and/or ADA experience/knowledge.
Strong investigative and analytical skills.
Strong customer service skills.
Strong written and oral communication skills.
Strong organizational and time management skills.
Ability to analyze documentation in the context of functional capacity/abilities.
Kean instincts on how to work in a team environment.
Continue education and maintain required licensure/certifications.

Responsibilities

Acts as a first level specialist resource for customer complaints and escalates issues; monitors reviewer tasking and ensures accuracy.
Manages relationships for customers and may lead appeals processes; ensures timely responses to customer needs.
Provides procedural guidance for referrals and co-management; develops business with existing customers.
Assists leadership in developing policies and best practices.
Analyzes production data and communicates insights to stakeholders.
Supports new accounts and initiatives; prioritizes workload and reports on co-management volumes.
Mentors staff, provides training and performance feedback.
Educates staff on disability and absence claims and ADA related cases.