Associate VB Claims Specialist

Unum is a leading provider of employee benefits, committed to helping employees thrive. The Associate VB Claims Specialist role is responsible for the adjudication of voluntary benefits claims, providing technical expertise and excellent customer service while learning to manage a caseload effectively.

Responsibilities

• Maintain organizational service standards on all assigned claims demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity
• Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including 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
• Develop skill set to determine appropriate risk management strategies through analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure appropriate eligibility requirements, liability decisions, and benefits payee
• Develop problem solving skills by demonstrating analytical and logical thinking resulting in the timely and accurate adjudication of a variety of simple to complex voluntary benefits claims
• Develop a working knowledge of systems needed for claims adjudication
• Provide excellent customer service and independently respond to all inquiries within service guidelines
• Responsible for timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (i.e., medical assessments, billing, etc.) as appropriate
• Produce objective, clear documentation and technical rationale for all claim determinations and demonstrate the ability to effectively communicate determinations while ensuring compliance with Voluntary Benefits procedures and all legal requirements including state regulations
• Partner and coordinate file strategies utilizing specialized resources including nurses, physicians, vocational rehabilitation and assessing medical documentation, when appropriate
• Ensure a timely and well communicated transfer process when transitioning integrated claims across lines of business, ensuring a coordinated and continuous claims experience for customers
• Be familiar with specialized workflow requirements and performance standards for any assigned customers
• May perform other duties as assigned

Skills

• 4-year degree preferred or equivalent work experience
• Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience
• Possess strong analytical, critical thinking, and problem-solving skills
• Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decision and ongoing medical management
• Able to effectively utilize a broad spectrum of resources, materials, and tools needed to assist with the decision-making process
• Strong service and quality orientation
• Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, sales representatives, etc
• Demonstrated ability to operate with a sense of urgency and make balanced decisions with the highest degree of integrity and fairness
• Excellent communication skills, written and verbal
• Meets the standards for this position, as defined in the Talent Management framework
• Medical background, voluntary benefits claims and/or disability management experience

Benefits

• 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.

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