Senior Leave & Disability Claims Specialist

Unum; Chattanooga (TN); On-site; USD 53,000 - 101,000; Full time

Benefits offered by this job

Health insurance

Vision coverage

Dental coverage

Short & Long-Term Disability

401(k) employer contribution

Paid time off

Job summary

Unum, headquartered in Chattanooga, TN, seeks an advanced claims professional to adjudicate complex short-term disability cases and provide guidance on FMLA and state leave regulations. You will interact with employees, employers, and health care providers while delivering accurate, timely decisions.

The role emphasizes technical expertise, coaching junior colleagues, and maintaining service standards. A 4-year degree or equivalent experience plus leave/disability background is preferred.

Qualifications

• 4-year degree preferred or equivalent work experience.
• 3 years or more years in the Leave or Disability Benefit Specialist role.
• Mastery of all key responsibilities and job specifications of either the Leave or Disability Benefit Specialist roles.
• Medical background, Disability claim and/or leave management experience preferred.
• Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions.
• Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc.
• Strong service and quality orientation.
• Possess strong analytical and problem-solving skills
• Meets the standards for this position, as defined in the Talent Management framework

Responsibilities

• Timely and accurate adjudication of complex STD claims
• Processing of leaves associated with an employee’s own health condition
• Apply technical contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements and liability decisions
• Determine complex eligibility and availability of leave for integrated claims/leaves
• Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and effective communication of rationale for claims action
• Determine and generate appropriate communications to comply with FMLA and State regulations and customer procedures
• Facilitate roundtables when consulted or manager is unavailable
• Provides technical coaching and mentor support to less experienced Benefit Center professionals
• Provides Manager/Director with performance and development feedback for assigned mentees
• Is viewed as a role model, technical expert and leader within the team and Benefits Center
• Provides coverage of daily tasks including customer inquiries and attending customer calls as needed and in times of management absence
• Verify on-going liability and return to work opportunities as appropriate
• Provide excellent customer service by paying appropriate claims promptly and quickly and independently responding to all inquiries within Benefits service guidelines
• Develop relationships with Employer contacts, including HR administrators
• Coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation
• Ensure timely referrals/notifications to other areas (i.e., LTD, medical assessments, etc) as appropriate
• Ensure a timely and well communicated transfer process when transitioning integrated claims from STD to LTD, ensuring a coordinated and continuous claims experience to employees
• Maintain organizational service standards on all assigned claims and leaves
• Be familiar with specialized workflow requirements and performance standards for any assigned customers
• May perform other duties as assigned

Skills

Analytical skills

Problem solving

Interpersonal skills

Independent judgment

Return-to-work strategy

Customer service

Education

4-year degree preferred

Job description

Unum, headquartered in Chattanooga, TN, seeks an advanced claims professional to adjudicate complex short-term disability cases and provide guidance on FMLA and state leave regulations. You will interact with employees, employers, and health care providers while delivering accurate, timely decisions.

The role emphasizes technical expertise, coaching junior colleagues, and maintaining service standards. A 4-year degree or equivalent experience plus leave/disability background is preferred.