Senior/Lead Appeals Specialist- LTD - UNUM
Portland, ME
About the Job
Job Posting End Date: November 07
When you join the team at Unum, you become part of an organization committed to helping you thrive.
Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
+ Award-winning culture
+ Inclusion and diversity as a priority
+ Performance Based Incentive Plans
+ Competitive benefits package that includes: 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
_*All the benefits listed above are subject to the terms of their individual Plans_ .
And that’s just the beginning…
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you’re directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!
General Summary:
This is first step in the Appeals career path. The Senior Appeals Specialist is responsible for providing and determining correct actions for appeals on varied product lines.
Principal Duties and Responsibilities
+ Manage and oversee caseload of appeals of ERISA and non-ERISA claims on multiple product lines within established timeliness and productivity standards with appropriate validation.
+ Ensure sound, impartial appeal decisions according to the contract based on the de novo review of medical, vocational, and legal facts of the claim.
+ Utilize appropriate resources, as needed, to arrive at thorough, fair, and objective appeal decisions.
+ Ensure compliance with ERISA and other regulatory standards, as applicable.
+ Develop Skills in identifying and recommending alternative appeals resolutions as appropriate.
+ Make balanced decisions and provide creative solutions with the highest degree of integrity and fairness.
+ Implement and interpret management policies and operating practices.
+ Ensure timely appeal decisions.
+ Ability to develop communication skills to effectively represent and defend the Company’s position as the authoritative corporate representative in litigation.
+ Establish and maintain extensive contact and communications with claimants, policyholders, physicians, attorneys, and other resources (internal and external), while managing the conflict that may arise in the claim.
+ Share feedback to Operations personnel on specific claim appeal decisions.
+ Extensive interaction with Operations, Complaints, Medical, Vocational, Legal, Audit, Sales Office, Policyholders, Claimants and Claimant’s Counsel.
+ Ability to effectively balance the quality and productivity expectations set by the Appeals department.
+ May perform other duties as assigned.
Job Specifications
+ 4 year degree strongly preferred or claims related experience.
+ Demonstrated technical ability combined with strong decision and analytical skills.
+ Capable of high level understanding of regulatory and legal requirements and ability to manage appeals in accordance with company standards for compliance with those requirements.
+ Capable of effectively communicating and defending the Company’s position as the authoritative corporate representative in a demanding litigation setting.
+ Capable of handling high volumes of appeals in a timely manner, meeting regulatory frameworks and company guidelines.
+ Capable of working independently and exercising discretion.
+ Ability to manage and prioritize diverse kinds of activities.
**There is flexibility in the opening, and we are evaluating individuals from varying levels. Position could be filled as Senior or Lead dependent upon experience.
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$53,300.00-$100,700.00
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 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. All benefits are subject to the terms and conditions of individual Plans.
Company:
Unum
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.
When you join the team at Unum, you become part of an organization committed to helping you thrive.
Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:
+ Award-winning culture
+ Inclusion and diversity as a priority
+ Performance Based Incentive Plans
+ Competitive benefits package that includes: 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
_*All the benefits listed above are subject to the terms of their individual Plans_ .
And that’s just the beginning…
With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you’re directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!
General Summary:
This is first step in the Appeals career path. The Senior Appeals Specialist is responsible for providing and determining correct actions for appeals on varied product lines.
Principal Duties and Responsibilities
+ Manage and oversee caseload of appeals of ERISA and non-ERISA claims on multiple product lines within established timeliness and productivity standards with appropriate validation.
+ Ensure sound, impartial appeal decisions according to the contract based on the de novo review of medical, vocational, and legal facts of the claim.
+ Utilize appropriate resources, as needed, to arrive at thorough, fair, and objective appeal decisions.
+ Ensure compliance with ERISA and other regulatory standards, as applicable.
+ Develop Skills in identifying and recommending alternative appeals resolutions as appropriate.
+ Make balanced decisions and provide creative solutions with the highest degree of integrity and fairness.
+ Implement and interpret management policies and operating practices.
+ Ensure timely appeal decisions.
+ Ability to develop communication skills to effectively represent and defend the Company’s position as the authoritative corporate representative in litigation.
+ Establish and maintain extensive contact and communications with claimants, policyholders, physicians, attorneys, and other resources (internal and external), while managing the conflict that may arise in the claim.
+ Share feedback to Operations personnel on specific claim appeal decisions.
+ Extensive interaction with Operations, Complaints, Medical, Vocational, Legal, Audit, Sales Office, Policyholders, Claimants and Claimant’s Counsel.
+ Ability to effectively balance the quality and productivity expectations set by the Appeals department.
+ May perform other duties as assigned.
Job Specifications
+ 4 year degree strongly preferred or claims related experience.
+ Demonstrated technical ability combined with strong decision and analytical skills.
+ Capable of high level understanding of regulatory and legal requirements and ability to manage appeals in accordance with company standards for compliance with those requirements.
+ Capable of effectively communicating and defending the Company’s position as the authoritative corporate representative in a demanding litigation setting.
+ Capable of handling high volumes of appeals in a timely manner, meeting regulatory frameworks and company guidelines.
+ Capable of working independently and exercising discretion.
+ Ability to manage and prioritize diverse kinds of activities.
**There is flexibility in the opening, and we are evaluating individuals from varying levels. Position could be filled as Senior or Lead dependent upon experience.
Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.
The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$53,300.00-$100,700.00
Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 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. All benefits are subject to the terms and conditions of individual Plans.
Company:
Unum
Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.
Source : UNUM
