Senior STD Benefits Specialist Trainee

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

Job Posting End Date: November 30

When you join the team at Unum, you become part of an organization committed to helping you thrive.

Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:

• Award-winning culture
• Inclusion and diversity as a priority
• Performance Based Incentive Plans
• Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
• Generous PTO (including paid time to volunteer!)
• Up to 9.5% 401(k) employer contribution
• Mental health support
• Career advancement opportunities
• Student loan repayment options
• Tuition reimbursement
• Flexible work environments
• *All the benefits listed above are subject to the terms of their individual Plans .

And that's just the beginning...

With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!

General Summary:

This position is the next step in the career path after the Benefits Specialist role within the Absence Management Organization (AMC), and is responsible for handling higher indemnity, more complex claims or larger corporate accounts.

The incumbent demonstrates well-developed claim skills, in-depth technical and systems knowledge as well as excellent customer service skills. In addition, the incumbent has demonstrated a higher level of proficiency and independence in all aspects of the claim management and decision-making process and can share their knowledge with lesser experienced employees.

Prior to movement to Lead Benefits Specialist incumbents in this position must demonstrate expert skills in claim management, contract interpretation and operation of systems. Additionally, the incumbent demonstrates mentoring and special project work.

Principal Duties and Responsibilities:

• Independently manage a full caseload of complex claims, ensuring appropriate sign offs are obtained. This may include responsibility for complex claims/accounts. Caseload size may vary by product(s).
• 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. Can effectively articulate rationale for action.
• 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.