Claims Technical Lead

Aflac, Incorporated•Windsor, CT

5d•$75,000 - $95,000•Remote

About The Position

Aflac is hiring a remote Claims Technical Lead who will work from home within the continental United States. Occasional office visits may be requested based on business needs, with advance notice. The role serves as a technical resource for case managers, supports their training and development, and helps ensure high-quality, timely claims decisions and service. The lead may also manage complex cases and customer escalations and will support management with team operations and special assignments.

Requirements

Bachelor’s degree in health administration, business, or a related field, or an equivalent combination of education and experience.
Four or more years of job-related experience.
Two years of case management experience in STD/LTD, life, absence management, or a related field or industry.
Ability to influence and champion change.
Excellent critical-thinking and decision-making skills.
Strong leadership and organizational skills.
Excellent verbal, written, and presentation communication skills.
Strong understanding of contracts, plans, and products.
Strong knowledge of best practices and effective case-management skills.

Responsibilities

Act as a main point of contact for claims-specific questions from case managers.
Mentor new hires and support new-hire training.
Take an active role in refresher training and the development of existing staff.
Ensure case managers use appropriate risk-management skills to secure appropriate claim outcomes.
Conduct manager reviews and audits of claims as necessary to ensure overall quality.
Provide coaching and feedback to case managers as needed.
Monitor KPIs and reports to ensure service levels and commitments are met, working with case managers as needed.
Monitor and adjust workload balancing for case managers.
Support management in facilitating team meetings and huddles.
Periodically manage complex cases and customer escalations.
Elevate trends and coaching opportunities to the leadership team.
Complete special projects and ad hoc assignments as requested by leadership.
Perform other related duties as required.

Benefits

Medical, dental, and vision coverage.
Prescription drug coverage.
Health care flexible spending account.
Dependent care flexible spending account.
Aflac supplemental Accident, Cancer, Critical Illness, and Hospital Indemnity policies offered at no cost to employees.
401(k) plans.
Annual bonuses.
Opportunity to purchase company stock.
11 paid holidays annually.
Up to 20 days of PTO to be used for any reason.
State-mandated sick leave, if eligible.
Other leaves of absence, if eligible, including adoption and parental leave.