Senior Benefits Claims Specialist - Complex Case Management

Unum; Chattanooga (TN); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Award-winning culture

Inclusion and diversity as a priority

Performance Based Incentive Plans

Health, Vision, Dental, Short & Long-‏

PTO including paid time to volunteer

401(k) employer contribution up to 9.5

Mental health support

Career advancement opportunities

Student loan repayment options

Tuition reimbursement

Flexible work environments

Job summary

Unum in Chattanooga, TN, seeks an experienced Lead Benefits Specialist in Absence Management to handle higher indemnity, more complex claims or larger corporate accounts. You will apply expert claim skills, analyze contracts and systems, and coach less experienced colleagues to uphold quality and service standards.

The role requires independent decision making, thorough documentation, and collaboration with other product teams.

Responsibilities

• Independently manage a full caseload of complex claims, ensuring appropriate sign offs are obtained.
• Independently build action plans, analyze outcomes and render a determination in accordance with our quality and service guidelines.
• Independently evaluate and analyze all information in claim files to determine appropriate action steps and adjudication of claims.
• Evaluate the need for and ensure timely referrals to others as appropriate.
• Undertake a timely, accurate claims review, initiate appropriate claim validation activities, and recommend either initial approval of benefits or denial of the claim.
• Display a thorough knowledge of products, policies/procedures, contracts and medical and vocational issues, financial and legal issues.
• Demonstrate a strong understanding of the applicable contract/policy definitions and relevant provisions, clauses, exclusions, riders and waivers as well as regulatory and statutory requirements for claim products administered.
• Apply contract/policy knowledge and analyze technical contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions and appropriate payee.
• Problem solve with an independent demonstration of analytical/ logical thinking, recognizing multiple connections, optimizing results by choosing the best strategies resulting in fair and impartial claim decisions.
• Verify on-going liability and develop strategies for return to work opportunities as appropriate. Demonstrate strong claim validation and return to work techniques, where applicable.
• Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively verbally communicate determinations.
• Demonstrate strong knowledge and effectively utilize a broad spectrum of materials and tools regarding contractual, medical, vocational, disability and RTW strategies, as required.
• Strong knowledge of the applicable claims system(s).
• Coordinate and share information with other products as appropriate.
• Provide timely and excellent customer service by paying appropriate claims promptly and quickly responding to all inquiries.
• Maintain organizational service and quality standards on all assigned claims.
• This position may be responsible for multiple lines of business as part of our integrated service model.
• Protects the Company against extra-contractual liabilities by following established guidelines and regulations.
• May be responsible for mentoring less experienced employees
• May perform other duties as assigned.

Job description

Unum in Chattanooga, TN, seeks an experienced Lead Benefits Specialist in Absence Management to handle higher indemnity, more complex claims or larger corporate accounts. You will apply expert claim skills, analyze contracts and systems, and coach less experienced colleagues to uphold quality and service standards.

The role requires independent decision making, thorough documentation, and collaboration with other product teams.