Senior STD Benefits Specialist Trainee

Unum•Portland, ME

12d•$45,600 - $86,200

About The Position

This position is a career step after Benefits Specialist within Unum’s Absence Management Organization. It handles higher-indemnity and more complex claims or larger corporate accounts. The specialist demonstrates well-developed claim-management skills, in-depth technical and systems knowledge, excellent customer service, and independence in claim management and decision-making. The role also shares knowledge with less experienced employees. Before advancing to Lead Benefits Specialist, the incumbent must demonstrate expert claim-management, contract-interpretation, and systems skills, along with mentoring and special-project experience. The role may cover multiple lines of business as part of an integrated service model.

Requirements

Mastery of the key responsibilities and job specifications of subordinate positions.
Excellent customer service skills.
Excellent verbal, written, listening, and interpersonal communication skills.
Strong analytical and problem-solving skills.
Ability to partner effectively with internal and external resources.
Strong negotiation skills, flexibility, and tolerance for ambiguous situations.
Strong knowledge of policies and contracts, medical terminology, relevant legislation, claim validation and early-intervention techniques, return-to-work assistance, and departmental practices and procedures, as appropriate.
Coaching and mentoring abilities.

Responsibilities

Independently manage a full caseload of complex claims, obtaining appropriate sign-offs; this may include complex claims or accounts, and caseload size may vary by product.
Build action plans, analyze outcomes, and make determinations in accordance with quality and service guidelines.
Evaluate and analyze claim-file information to determine appropriate next steps and claim adjudication.
Assess the need for referrals and ensure timely referrals to others when appropriate.
Conduct timely and accurate claims reviews, initiate claim-validation activities, and recommend initial benefit approval or claim denial, articulating the rationale for the action.
Apply knowledge of products, policies, procedures, contracts, medical and vocational issues, financial and legal issues, and applicable regulatory and statutory requirements.
Analyze policy and contract provisions to determine eligibility requirements, liability, and appropriate payees.
Use independent analytical and logical problem-solving to reach fair and impartial claim decisions.
Verify ongoing liability and develop return-to-work strategies where appropriate.
Prepare objective, clear documentation and technical rationales for claim determinations, and communicate determinations effectively.
Use contractual, medical, vocational, disability, and return-to-work materials and tools as required.
Use applicable claims systems effectively.
Coordinate and share information with other products as appropriate.
Provide timely customer service by paying appropriate claims promptly and responding quickly to inquiries.
Maintain organizational service and quality standards on assigned claims.
Protect the company against extra-contractual liabilities by following established guidelines and regulations.
Mentor less experienced employees when needed.
Perform other duties as assigned.