Senior STD Benefits Specialist Trainee

Unum Group•Chattanooga, TN

10d

About The Position

This position is the next step in the Benefits Specialist career path within the Absence Management Organization. It handles higher-indemnity, more complex claims or larger corporate accounts and requires well-developed claims skills, in-depth technical and systems knowledge, excellent customer service, and a high degree of proficiency and independence in claims management and decision-making. The specialist shares knowledge with less experienced employees and may mentor them or participate in special projects. Before advancing to Lead Benefits Specialist, incumbents must demonstrate expert skills in claims management, contract interpretation, and systems operation, along with mentoring and special-project experience. The role independently manages a full caseload of complex claims, evaluates claim information, develops action plans, and makes determinations in accordance with quality and service guidelines. It requires applying policy and contract knowledge, medical and vocational considerations, and relevant legal, financial, regulatory, and statutory requirements. The specialist documents and communicates determinations, coordinates with other products and resources, provides timely customer service, and follows established guidelines to protect the company against extra-contractual liabilities. Caseload size may vary by product, and the role may cover multiple lines of business.

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.
Strong 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, early intervention techniques, return-to-work assistance, and departmental practices and procedures, as appropriate.
Ability to develop coaching and mentoring skills.

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 determine claim outcomes in accordance with quality and service guidelines.
Evaluate claim-file information to determine appropriate action steps and adjudicate claims.
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; clearly explain the rationale for actions.
Apply knowledge of products, policies, procedures, contracts, medical and vocational issues, and financial and legal issues.
Apply contract and policy definitions, provisions, clauses, exclusions, riders, waivers, and applicable regulatory and statutory requirements.
Analyze contractual requirements to determine eligibility, liability, and the appropriate payee.
Use analytical and logical problem-solving to reach fair and impartial claim decisions.
Verify ongoing liability and develop return-to-work strategies when appropriate.
Use claim-validation and return-to-work techniques where applicable.
Prepare objective, clear documentation and technical rationales for claim determinations, and communicate determinations verbally.
Use relevant contractual, medical, vocational, disability, and return-to-work materials and tools, as required.
Use applicable claims systems and coordinate information with other products when appropriate.
Provide timely customer service by paying appropriate claims promptly and responding quickly to inquiries.
Maintain organizational service and quality standards on assigned claims.
Follow established guidelines and regulations to protect the company against extra-contractual liabilities.
Mentor less experienced employees when assigned.
Perform other duties as assigned.