Associate VB Claims Specialist

Unum•Portland, ME

1d•Hybrid

About The Position

This is an entry-level position within the Voluntary Benefits Claims Organization. This position is responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims in conjunction with providing technical expertise regarding applicable regulations. This position is responsible for providing excellent customer service and interacts on a regular basis with employees, employers, health care providers and other specialized internal resources. Incumbents in this role are considered trainees and are assigned a formal mentor for 6-12 months until they are assessed as capable of independent work. Incumbents are primarily responsible for learning and developing the skills, knowledge, and behaviors necessary to successfully adjudicate assigned claims, in accordance with our claims philosophy and policies and procedures. Incumbent must demonstrate the ability to effectively manage an assigned caseload, exercise discretion and independent judgment, and appropriately render timely claim decisions while demonstrating strong customer service prior to movement to the exempt level claims specialist role.

Requirements

4-year degree preferred or equivalent work experience
Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience
Possess strong analytical, critical thinking, and problem-solving skills
Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decision and ongoing medical management.
Able to effectively utilize a broad spectrum of resources, materials, and tools needed to assist with the decision-making process
Strong service and quality orientation.
Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc.
Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness.
Excellent communication skills, written and verbal
Meets the standards for this position, as defined in the Talent Management framework

Nice To Haves

Medical background, voluntary benefits claims and/or disability management experience preferred

Responsibilities

Maintain organizational service standards on all assigned claims demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity.
Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including products, policies, procedures, and contracts.
Develop an 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.
Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions, and benefits payee.
Develop problem solving skills by demonstrating analytical and logical thinking resulting in the timely and accurate adjudication of a variety of simple to complex voluntary benefits claims.
Develop a working knowledge of systems needed for claims adjudication.
Provide excellent customer service and independently respond to all inquiries within service guidelines.
Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (i.e., medical assessments, billing, etc.) as appropriate.
Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively communicate determinations while ensuring compliance with Voluntary Benefits procedures and all legal requirements including state regulations.
Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation, when appropriate.
Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business, ensuring a coordinated and continuous claims experience for customers.
Be familiar with specialized workflow requirements and performance standards for any assigned customers.
May perform other duties as assigned.

Benefits

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
Healthcare benefits (health, vision, dental)
Insurance benefits (short & long-term disability)
Performance-based incentive plans
Paid time off
401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not.