United States Minor Outlying Islands. Tennessee, California, Illinois, Minnesota, Pennsylvania, Washington, Remote USA, Salary starts at @$16.00 per hr+
Unum is a company of people serving people. As one of the world's leading employee benefits providers and a Fortune 500 company, Unum's financial protection benefits help protect more than 36 million working people and their families from the financial impact of illness or injury. Unum's three distinct, but similarly focused US businesses – Unum US, Colonial Life, and Starmount Life – are each a market leader in making disability, life, accident, critical illness, dental, and vision insurance accessible in the workplace.
Headquartered in Chattanooga, Tennessee, Unum also has significant US operations in Portland, Maine, - and over 35 field offices nationwide. Colonial Life is headquartered in Columbia, South Carolina with over 40 field offices nationwide. Starmount Life is based in Baton Rouge, Louisiana, and is the dental and vision center of excellence for Unum in the US. Read employee reviews here
General Summary:
SUMMARY DESCRIPTION
The Claims Administrative Assistant is responsible for handling all payment runs for both the Data Dental and Quantum Choice claim systems. Currently, payment runs occur three times a week but maybe increased to daily. Act as a direct liaison to VPAY, our third-party administrator for all payments issued to either providers or members. The incumbent assists with collections and projects as needed.
At this time, due to COVID-19, all training will start remote (unless you request to be in office). Once we return to normal operations, if you are within 100 miles of one of our offices in Chattanooga, TN; Baton Rouge, LA; Columbia, SC or Portland, ME and you’ve accepted a position, you will have an onsite/work at home hybrid work arrangement.
Responsibilities
Responsible for all payment runs for both the Data Dental and Quantum Choice claim systems.
VPAY business liaison – works directly with VPAY to handle all research issues, questions, voids and reissues.
Responsible for all research and analysis on Returned Checks from Providers to determine root cause, as to why check returned; and if payment sent in error; ensures claim payment is corrected if needed. Phone development with provider may be needed; and Group Administrative Assistant performs all calls.
Responsible for all research on Returned Checks from Post Office to determine root cause. Phone development with provider or member may be needed; and Group Administrative Assistant performs
Responsible for conducting all Payment Voids and Reissues research and requests from all areas of the company; notably Provider Relations and Customer Service.
Assist Accounting Department with any and all VPAY reconciliations, collections, and refunds.
Assist Director with projects and duties assigned.
Job Specifications
Strong research and analysis skills
Strong organizational and time management skills
Excellent customer service philosophy
Critical thinking and problem-solving abilities
Knowledge of vision/dental industry preferred
High school diploma or equivalent
Minimum 2 years of claims, book-keeping/accounts receivable/payable, or equivalent experience.
Job Description
This role is a 6-month contract position to start with an opportunity for an additional 6-month extension. We are looking for a talented Technical Sourcer to join the Digital Transformation Talent Acquisition Team that is tasked to build pipelines and proactively capture top talent in a highly competitive technical market. In this role, as a Technical Sourcer, you will be seen as the subject matter expert with current knowledge of the technical talent market and provide active applicants and passively sourced candidates to the Digital Transformation Talent Acquisition Team for consideration.
Qualifications
Bachelor's degree or equivalent experience
3+ years of technical sourcing experience in a highly competitive market
Experience sourcing technical talent such as Full Stack Developers, Product Owners/Managers, Software
Engineers, Solution Architects, DevOps Engineers, Site Reliability Engineers, etc.…
Search firm and/or corporate recruiting experience with a focus on technical talent strongly preferred
Proficiency using LinkedIn Recruiter
Experience using social media tools for sourcing and branding efforts; tools include but not limited to: LinkedIn, Twitter, Instagram, etc.
Experience building pipeline of qualified talent and surfacing talent against open roles proactively
Experience in consulting and/or working in a consultative role where multiple projects and competing demands are the norms
Knowledge and expertise in internet data mining, professional networking, passive candidate cold calling and innovative sourcing techniques
Boolean and/or Semantic searching experience
Experience using CRM, TRM or ATS tools – e.g. Workday, Phenom, Salesforce, Taleo, Jobvite, Beamery, Avature, SmashFly, iCIMS, etc.
Demonstrated experience developing strong, collaborative relationships and partnering with team members towards a common goal
Experience maintaining confidential information
Strong interpersonal capabilities and communication skills.
General Summary:
Unum is looking for a Data Analyst to join their Data & Integration team and be a major contributor to their success. You will be responsible for data profiling and analysis in order to choose the most appropriate source of business information. You will be in charge of ensuring that the source-to-target data mapping standards are followed (e.g. source to target can be from one DBMS table to another DBMS table, from a DBMS table into a canonical message structure, etc.) You will work in collaboration with analysts, engineers, and DBAs to develop simple to moderately advanced, adaptive data models that are easy to maintain (conceptual and logical).
Job Specifications
Bachelor's Degree preferred, ideally with a concentration in Data Analysis/Data Science, Computer Science, or Information Technology
4+ years experience working in Business Analytics/Finance/Business Management/Statistics
Exceptional capabilities with SQL
Experience with either Teradata or DB2 helpful
Exposure to MongoDB
Experience with another programming/scripting languages i.e. Python, SAS, or R highly desired
Mastery of data profiling and analysis concepts, including data anomalies, & data mapping activities.
Mastery of data modeling concepts
Clearly demonstrates data analytical ability and critical thinking skills
Ability to manage multiple tasks by paying close attention to detail
Takes an innovative approach to problem-solving
Strong communications skills
Strong team player; able to work effectively within a team and more broadly with people from a variety of backgrounds and areas across the organization.
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General Summary:
The Acquisition & Products Journey at Unum is looking for a creative Program Manager. Establishing leadership routines and practices, managing corporate operations, and driving strategy and planning processes are all responsibilities you'll have. With the help of the Technology team, you'll be promoting the usage of standard Enterprise Technology practices and contributing to continuous improvement initiatives. In addition, you'll be responsible for budget formulation, resource, and capacity planning, establishing operating plans for programs, and ensuring that programs are effectively tracking to their plans. When it comes to IT project management, the Program Manager should have experience in both traditional and Agile methods of project management.
Job Specifications
BA/BS in computer science/technology or business, or equivalent work experience, MS or MBA preferred
3 or more years IT/IS leadership, large program, or Management/consulting experience
Program and Change Management expertise
Demonstrates advanced understanding of and experience with Agile, Scaled Agile and the overall Product Development Lifecycle
Has excellent communication skills, both written and verbal
Strong team player and able to effectively collaborate across multiple stakeholder groups
Comfortable with ambiguity and able to translate into tangible action plans.
Able to create a variety of documents, process maps, dashboards, and presentations suitable for technical, business and executive audiences using a variety of tools
Demonstrates program management, communication, and leadership skills on large, complex initiatives
Project/program management certifications like PMP, Prince2, CSM, CSPO, CSP and/or CSC are a plus
Will work with their manager on strategic planning process, communication of strategic and organizational priorities
Develop governance to monitor and support implementation of strategic priorities
Develop executive presentations and strategic materials
Identify decisions that need to be made to support strategy, ensuring decisions are made by the right team leaders and monitor ongoing progress
Partner with various journey and business teams on portfolio metrics and cost analysis and provide regular reports to senior leadership
Will partner and be an extension for the senior leadership team
Plans the realization of business benefit so that the success of each project can be measured retrospectively by reference to the performance of its persistent products in the business environments.
Provides visibility for and coordinates dependencies across multiple teams (within and outside of assigned organization).
Identifies, proposes and initiates process improvement activities within the organization.
Owns and drives opportunities that will have a measurable effect on operational effectiveness.
Identifies, analyzes and deploys appropriate management strategies for the risks associated with projects. Monitors risks as their proximity, likelihood and impact evolve and modifies plans for their management appropriately.
Coordinate with other Project Managers and business units, to ensure appropriate resource allocations are in place to support the business goals
Own and support department vendor relationships and management
Resolves conflicts and pursues solutions that all parties can support while furthering the goals of the organization.
Act as the champion for the team and highlight achievements regularly across various internal channels.
General Summary:
General Summary
This is an entry level position within the Benefits Organization. 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 a high volume of assigned claims, in accordance with our claims philosophy and policies and procedures.
Incumbent must demonstrate the ability to effectively manage an assigned caseload, the ability to exercise discretion and independent judgment and the ability to appropriately render timely claim decisions, demonstrating strong customer service prior to movement to exempt level benefits specialist role.
Job Specifications
High School Diploma or equivalent, required
Customer service / decision making experience and/or College experience.
Able to utilize claim evaluation techniques to identify and evaluate claim information in a timely, fair and objective manner.
Detail oriented; able to analyze and research contract information.
Able to maintain a high level of confidence to make fair and appropriate decisions even in the face of disagreement, while also being open and flexible to changing opinion based on new information.
Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness.
Able to influence others to reach appropriate and constructive conclusions.
PC skills are essential; ability to operate effectively in an imaged environment.
Demonstrated ability to multitask and balance goals and priorities effectively in a high-volume environment.
Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
Excellent customer service skills.
Strong communication; verbal, written, and listening, as well as strong interpersonal skills
Possess analytical and problem-solving skills .
As a Long-Term Disability Benefit Specialist Trainee, you will be responsible for learning and developing the skills necessary to successfully adjudicate assigned claims in accordance with our philosophy and policies.
Trainees must demonstrate the ability to effectively manage an assigned caseload, the ability to exercise discretion and independent judgment and the ability to appropriately render timely claim decisions, demonstrating strong customer service prior to movement to exempt level benefits specialist role.
Principal Duties and Responsibilities
Develop skills to manage a caseload of complex claims; ensuring appropriate sign offs are obtained. Caseload size may vary by product(s).
Develop an understanding and working knowledge of Unum 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.
Apply contract/policy knowledge and analyze technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions and appropriate payee.
Develop problem solving skills by demonstrating analytical/ logical thinking, recognizing multiple connections, optimizing results by choosing the best strategies resulting in fair and objective claim decisions.
Verify on-going liability and develop strategies for return to work opportunities as appropriate. Develop and strengthen 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.
Develop knowledge and effectively utilize a broad spectrum of resources, materials and tools regarding contractual, medical, vocational, disability and RTW strategies, as required.
Develop an operating 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 expected service and quality standards on all assigned claims.
Protects the Company against extra-contractual liabilities by following established guidelines and regulations
May perform other duties as assigned.
The Credentialing Specialist is responsible for the credentialing and recredentialing of providers in compliance with internal standards, policies and procedures. This includes entering data, performing appropriate credentialing verifications, preparing and files for various internal and external entities. The Credentialing Specialist will assist in conducting Credentialing Delegation Reviews as well as preparation and delivery of monthly and quarterly reporting for various persons.
Principal Duties and Responsibilities
Works directly with providers to ensure all necessary credentialing information has been received prior to beginning the credentialing process
Enters provider data into appropriate data management systems
Performs all credentialing verifications necessary to complete the credentialing process while maintaining the appropriate compliance standards
Prepares and presents providers records for Credentialing Committee Review
Notifies providers of credentialing decisions within compliance timeframes
Assists providers with all questions related to provider credentialing
Performs provider re-credentialing, at least every 36 months in compliance with NCQA standards
Assists with Credentialing Delegation Reviews by presenting credentialing files to various Delegated Entities and/or reviewing credentialing files, policies and procedures and other monitoring reports to ensure compliance of various Delegated Entities
Assists in preparing and delivering monthly and quarterly reports to various Delegated Entities
Assists in monitoring of license expirations and any change in status and takes action when appropriate
Assists in reviewing and updating criteria and credentialing policies and procedures, as necessary, but at least annually
Educates providers regarding criteria and credentialing policies and procedures when necessary
Works with Network Management to ensure providers’ initial information and updates are sent for processing timely and accurately
Assists Network Management and Support staff with provider data management as it relates to adding new providers in System of Records
Always maintains provider and patient confidentiality
Provides positive, supportive, communication to providers at all times
Collaborates with other departments and outside agencies to meet identified needs of the providers and their patients, while also ensuring credentialing staff cooperation
Other duties as may be assigned
Job Specifications
Associates degree preferred or equivalent experience
Minimum 3+ years of experience in Provider Credentialing or equivalent experience
Strong verbal and written communication skills
Strong data entry skills
High level of accuracy and attention to detail
Ability to gain high level of knowledge involving intricate aspects of Systems of Record
Strong customer service philosophy
Critical thinking and problem-solving abilities
Familiarity with Microsoft Office, with strong Excel skills
Ability to thrive in a fast-paced environment and meet assigned deadlines.
Principal Duties and Responsibilities
Development and execution of comprehensive sourcing and recruitment strategies for exempt and non-exempt openings which position Unum to meet current and ongoing staffing requirements.
Development of strong rapport/working relationships with diverse audiences including but not limited to business management; faculty and academic administration; student organizations, vendors and community resources.
Expertly cold call, network, recruit and close candidates.
Consult and educate managers and selection teams on recruiting and selection-related topics and issues.
Proactively source and identify candidates for pipeline and introduce to hiring managers.
Evaluation and selection of colleges and universities from which to source candidates and develop relationships, based on business needs.
Plan, coordinate and execute on-campus recruitment efforts (information sessions, career fairs, interviews).
Set challenging performance goals and high-performance standards to support achievement of business results.
Promote the employee referral bonus program to create additional pools of quality talent.
Provide expertise on the regional employment market to ensure competitiveness in hiring.
Develop alternative recruiting strategies as needed.
May perform other duties as assigned.
Job Specifications
Bachelor’s degree required.
5+ years of successful recruitment and selection experience required.
3+ years of recruiting for roles in a designated area of specialism required.
Insurance industry experience and HR certifications preferred.
Ability and willingness to travel up to 25% of the time.
Strong written and oral communication skills; highly organized.
Strong knowledge of OFCCP requirements and expertise in effectively managing full life cycle recruitment.
Ability to handle sensitive and confidential information appropriately.
Demonstrated ability to perform at both strategic and tactical levels.
An expert level of knowledge in all full lifecycle recruiting components including, but not limited to, sourcing, qualifying, networking, assessing, legal, job analysis, wage and salary trends, relationship management, and due diligence.
Excellent negotiation, decision making and persuasion skills.
General Summary:
The Senior Underwriter will demonstrate strong risk evaluation, selection and retention of profitable business within assigned authority limits. This also requires a strong ability to partner with Company sales teams, brokers and all internal partners.
Principal Duties and Responsibilities
Consult with sales and service partners to provide the products and plan options that best meet the needs of our customers.
Evaluate and select risk to ensure the profitable acquisition of new cases and the continued profitable retention of in force cases.
Conduct high quality risk assessments on all cases to assure business guidelines, target profit and metrics are met. Identify and analyze risk trends, making recommendations for addressing these
Maintain a fully developed knowledge of the Company’s products, the sales, implementation, and enrollment processes, and market place influences
Deliver dependable, accurate, and timely service while maintaining relationships with internal and external partners
Assist with training, technical development and mentoring more junior underwriters
Job Specifications
Bachelors degree or equivalent, relevant business experience
Demonstrated, consistent proficiency at Underwriter level
Fully developed knowledge of product provisions, plan designs, pricing and contractual benefits
Strong technical expertise in risk selection
Demonstrated understanding of top-line and bottom-line objectives
Exhibit strong knowledge of sales/distribution process and market trends
Solid mentoring and coaching skills
Strong creative problem solving skills
Strong critical thinking/analytical reasoning skills
Strong communication skills, both verbal and written
Strong organizational skills and ability to handle multiple priorities
Strong ability to be persuasive and to negotiate
Demonstrated ability to work both independently and in a team environment
Exhibit a strong commitment to quality and personal ownership of results
Principal Duties and Responsibilities
Be the callers go-to person by being there, on time, ready to help them via multiple avenues of communication with timely and accurate information regarding policy and coverage-related questions.
Meet or exceed company goals and metrics to guarantee the best experience for callers.
Be open and motivated by feedback and guidance to be at your best for callers.
Protect members’ privacy and reassure them with empathy and professionalism.
Be available to work a regularly assigned shift between the hours of 8:00 am and 8:00 pm Eastern time. If scheduled for Saturday, between the hours of 10:00 am and 4:00 pm.
Reliable attendance in accordance with contact center attendance guidelines.
Complete all required training without missing any content.
Ability to obtain information from multiple systems and relay to callers in a seamless manner.
Follow all documented processes/workflow to enhance customer service and reduce customer effort/operating efficiency.
Utilize resources and tools to accurately respond to caller inquiries.
Meet the expectations of the quality/productivity standards.
Demonstrate a passion for the values outlined in the We are Unum value statements.
May serve as a certified mentor, as needed by assisting with questions from co-workers in Team chats.
May perform other duties as assigned.
Job Specifications
1 year successful experience in a Contact Center, with a strong preference that the experience be in the insurance/healthcare/medical/financial field or equivalent area.
College degree or equivalent work experience preferred.
Successful completion of Contact Center cross-training program, including demonstrating on phone proficiency and passing required knowledge checks.
Prior successful job progression and promotions with increased responsibilities.
Strong verbal/written communication and interpersonal skills, both in English and Spanish.
Answering customer queries in Spanish, translating documents and acting as an interpreter.
A passion for helping customers and exceeding their expectations with high integrity.
Excellent verbal and written communication skills with the ability to flex your communication style to best meet the needs of customers.
Enthusiasm for working in a fast-paced, structured environment, answering numerous inquiries for customers at their greatest time of need.
Strong computer and multi-tasking skills as well as the ability to confidently work in multiple systems with dual monitors.
Familiarity with Microsoft applications such as Outlook, Word, and Excel.
Intellectual curiosity and a desire to continually learn and grow.
An excellent work ethic and ability to adapt and work successfully in a continually changing environment.
Dependability – being there when needed by teammates and customers.
If working from home, access to a desk, chair, and a dedicated workspace, free from distractions. Strong and reliable internet speed, with speeds of 25 MB download, 5 MB upload. (DSL is not an option for this position.)
Comfortable with video communications via MS Teams throughout the day to communicate with teammates and leadership face to (virtual) face.
The position retains a semi-structured relationship with an assigned mentor(s)/trainer for a minimum 6-month period or until they are assessed as capable of managing their assigned caseloads independently within 9 months. Mentor/trainer sign-off is required for all day-to-day claims activities until VBS is able to be released from day to day monitoring at which time VBS Manager will sign off on the key milestones. In order to move to VBS II
One must have two quality audit scores, within a four month period meeting minimum standards.
Incumbent will meet expected caseload at conclusion of formal training. Incumbents must demonstrate ability to effectively and independently manage expected caseload of a VBS II role for advancement.
Principal Duties and Responsibilities
Develop an understanding and working knowledge of VB products, policies and contracts.
Includes applicable policy definitions of relevant provisions, clauses, exclusions, riders and waivers as well as statutory requirements.
Become familiar with reference materials and tools regarding medical, vocational and claim issues and how / when to use these resources
Develop basic medical and technical claims skills and an understanding of claim practices and procedures.
Develop an operating knowledge of the applicable claims system(s)
Provide customer service in accordance with our "Commitment of Service" and other organizational service standards.
Develop sound independent decisions
May perform other duties as assigned
Job Specifications
College degree preferred or equivalent work experience.
Able to utilize claim investigative techniques to identify and evaluate claim information in a fair and objective manner.
Detail oriented; able to analyze and research policy information
Able to hold fast to fair and appropriate decisions even in the face of disagreement while being open to reconsider previous decisions based on new information.
PC skills are essential; ability to operate effectively in an imaged environment.
Able to work with others in a highly collaborative team environment.
Demonstrated ability to multitask and balance goals and priorities in a high volume environment.
Solid customer service skills.
Able to communicate effectively both verbally and in writing.
Problem solving skills are essential.
Basic math skills are essential.
Adaptable to change.
Operating knowledge of claim payment system(s) a plus.
Medical background and/or claim experience preferred.
This position is accountable for the accurate and efficient intake of new claims. The representative must exercise independent judgment and be fully versed on FMLA and applicable state leave laws as well customer-specific processing requirements. Associates in this role will be interacting with claimants/employers and partnering with other business areas (Benefits Center, Contact Center, etc.); therefore, strong customer service/communication orientation is a core competency while demonstrating the ability to operate across various systems and product workflows
Salary: The starting salary is $40,000 and we do account for geographic differentials in cost of living.
#Principal Duties and Responsibilities
Complete processing of new leaves and complete all daily follow-ups assigned
Determine eligibility and availability of leave time for each employee requesting leave for FMLA, State, and applicable Corporate protections
Determine and generate appropriate communications to comply with FMLA and State regulations and customer procedures
Independently determine appropriate status of leave under FMLA and state leave regulations taking into consideration regulatory requirements, company-specific requirements.
Determine and provide initial Short-Term Disability eligibility evaluation
Systematic initiation of new claims in support of various Unum product types utilizing the appropriate claim adjudication system.
Perform a policy coverage search to determine claim filing eligibility and process/triage based on standard and/or customized policy instructions.
Manage pending/incomplete prior to triage/assignment to the corresponding claims organization/team.
Contribute to individual quality/production expectations to ensure the achievement of organizational turnaround time expectations.
Promote a positive customer service experience through prompt, accurate and courteous responses to internal and external customers’ expectations.
Continue to build additional knowledge and understanding of the Unum business
Participate in training/development of new staff.
Identify trends, issues and innovative ideas and partner in solutions.
Identify and capitalize on best practices to ensure consistency and optimal performance in a team based environment.
Identify and share process improvements to enhance customer service.
Demonstrate leadership by promoting a positive team environment which results in motivated and empowered peers.
Support various project work as needed.
May perform other duties as needed.
Job Specifications
High school diploma or equivalent required. 4-year degree or similar experience preferred
Schedule for this role is 8-5EST, Monday – Friday. Although these will be the core hours, overtime may be requested/required outside of those hours.
Understanding of STD processes and work flows and insurance industry preferred
Demonstrate research and problem-solving skills
Ability to multi-task, with a demonstrated ability to work in a fast-paced environment handling a large volume of work
Action oriented, results driven and a team player that includes working with team members in a cross-site work environment
Possess an innovative mindset and is adaptable to change; ability to deal with multiple, concurrent and rapidly changing demands
Seeks out job challenges and opportunities to constantly improve skills
Strong interpersonal skills and customer relationship skills
Strong business communication skills (telephone, e-mail, written)
Knowledge of Windows; general keyboard and computer skills (Word, Excel, Access)
Decision making and analytical skills
Attention to detail and organizational skills
Strong work ethic with consistent job attendance history
General Summary:
Claim Management employees are responsible for processing of claims, review of medical certifications, and ongoing relationship management with employees requesting leaves and their Employer contacts. This person must exercise a high level of independent judgment and critical thinking in decision making, and applicable state laws as well customer specific processing requirements. Partnering with other business areas (Benefits Center, Contact Center, etc.) is also important to the success of the Claim Management operation. Incumbents in this position will receive training and be supported by a trainer/mentor.
.Principal Duties and Responsibilities
Processing of new claims and all daily follow-ups assigned
Determine eligibility and availability of claim time for each employee request
Determine and generate appropriate communications to internal and external customers
Review medical certifications and other documentation submitted; consult with our Medical and Clinical staff if needed
Review state regulations taking into consideration regulatory requirements, company-specific requirements, and analysis of documentation received (medical, legal, etc.)
Communicate medical or absence information with other internal units
Management of a leave through duration, reporting status to Employer, employee and other internal units
Respond to claimant questions and issues from employees or Employer contacts
Successful completion of training program
May perform other duties as assigned
Job Specifications
4-year degree or similar experience preferred
Strong interpersonal skills and customer relationship skills
Strong business communication skills (telephone, e-mail, written)
Knowledge of Windows/Microsoft Office suit; general keyboard and computer skills (Word, Excel, Outlook)
Decision making and analytical skills
Attention to detail and organizational skills
Understanding of supplemental insurance industry preferred
General Summary:
Prinipal Duties and Responsibilities
Develop skills to manage a large volume of claims; ensuring appropriate sign-offs are obtained. Caseload size may vary by product(s).
Develop an understanding and working knowledge of Unum 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.
Apply contract/policy knowledge and analyze technical contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions and appropriate payee.
Develop problem solving skills by demonstrating analytical/ logical thinking, recognizing multiple connections, optimizing results by choosing the best strategies resulting in fair and objective claim decisions.
Verify on-going liability and develop strategies for return to work opportunities as appropriate. Develop and strengthen 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.
Develop knowledge and effectively utilize a broad spectrum of materials and tools regarding contractual, medical, vocational, disability and RTW strategies, as required.
Develop an operating 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 expected service and quality standards on all assigned claims.
Protects the Company against extra-contractual liabilities by following established guidelines and regulations.
May perform other duties as assigned.
Job Specifications
High School Diploma or equivalent, required
Customer service / decision making experience and/or College experience.
Able to utilize claim evaluation techniques to identify and evaluate claim information in a timely, fair and objective manner.
Detail oriented; able to analyze and research contract information.
Able to maintain a high level of confidence to make fair and appropriate decisions even in the face of disagreement, while also being open and flexible to changing opinion based on new information.
Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness.
Able to influence others to reach appropriate and constructive conclusions.
PC skills are essential; ability to operate effectively in an imaged environment.
Demonstrated ability to multitask and balance goals and priorities effectively in a high-volume environment.
Self-motivated, independent with proven ability to work effectively on a team and work with others in a highly collaborative team environment.
Excellent customer service skills.
Strong communication; verbal, written, and listening, as well as strong interpersonal skills
Possess analytical and problem-solving skills
General Summary:
Associate Leave Reps are responsible for understanding the FMLA and state regulations, processing of leaves, review of medical certifications, and ongoing relationship management with employees requesting leaves and their Employer contacts. The leave specialist must exercise a high level of independent judgment and critical thinking in decision making, and be fully versed on the FMLA, applicable state leave laws as well customer specific processing requirements. Partnering with other business areas (Benefits Center, Contact Center, etc.) is also important to the success of the leave management operation. This position remains under the supervision and guidance of a Trainer/Mentor.
Principal Duties and Responsibilities
Processing of new leaves and all daily follow-ups assigned
Determine eligibility and availability of leave time for each employee requesting leave for FMLA, State, and applicable Corporate protections
Determine and generate appropriate communications to comply with FMLA regulations and customer procedures
Review medical certifications and other documentation submitted; consult with Nurse Case Manager and IME unit if needed
Determine the appropriate status of leave under FMLA and state leave regulations taking into consideration regulatory requirements, company-specific requirements, and analysis of documentation received (medical, legal, etc.)
Communicate medical or absence information with other internal units (STD, Intake)
Management of a leave through duration, reporting status to Employer, employee and other internal units
Respond to leave questions and issues from employees or Employer contacts
May perform other duties as assigned
General Summary
This position is responsible for producing consistently accurate and timely rates for customers with a vast range in complexity. Specialists support the evaluation and selection of risk and the establishment of premium levels which ensure profitable acquisition of new cases and/or the continued profitable retention of inforce cases.
Primary accountability is to determine the proper plan design and census manipulation needed to build the appropriate rate. The quality, accuracy, and reasonableness of the rate serves as the foundation for accurate risk assessment and ultimate pricing decisions that follow. This role requires a strong partnership with Underwriters, peers and other partners to ensure all data needs are met, work hand-offs are effectively communicated, and due dates are managed.
The incumbent must have strong technical understanding of products in the Unum US portfolio that may include: Group Long and Short-Term Disability, Group Life & AD&D, Dental, Vision, Paid Leave, Statutory Disability, Stop Loss, or the Voluntary Benefits Portfolio. In support of the sales teams and underwriting, the Specialist is accountable to understand requested plan designs through the analysis of complex inforce contracts and supplied materials, make appropriate decisions about the application of risk rules or escalation needs, and generate accurate rates to be used toward the creation of proposals. This individual may also provide specialized subject matter expertise on various products and processes as needed to support complex business.
Principal Duties and Responsibilities
Manage the quote process for quote requests by evaluating and executing technical aspects of the rating process to generate accurate rates for each product requested
Identify standard and non-standard business procedures and processes appropriately. Apply underwriting risk and escalation rules, accurately evaluate SIC classifications for the customer, handle PII census data according to department standards, and generate rates and proposals within service standards
Leverage tools appropriately to come to the right risk and pricing outcome on new business, enforce business and/or renewals
Determine the useability of and ensure accurate preparation of complex census data using word and excel
When provided, demonstrate an ability to most closely match in-force plan designs based on a review of Requests for Proposal, Benefit Summaries, complex contracts, and/or internal Unum systems (i.e. CME, EDS, etc.)
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