STD & LTD Benefit Claim Specialist/Sr./Lead (Workplace Solutions)-Omaha, NE and/or Chattanooga, TN

Location: Nebraska, Tennessee
Work Type: Full Time Regular
Job No: 500449
Categories: Customer Service, Claims/Claims Processing
Application Closes: Closes Jun 28, 2022

Ensures the accurate, prompt and thorough evaluation and management of disability claims by analyzing and determining the appropriate action steps while adhering to both internal and external regulations and ensuring an industry leading customer experience. This role has direct impact on the success of BSD from both a financial and persistency (customer retention) perspective.

Performs end to end claims evaluation, management and adjudication for Disability claims beginning at the point of notification through the maximum benefit/duration of the claim with the primary accountability being accurate and timely decision making of approved or denied liability benefits for the duration of the claim by managing to the appropriate duration based upon the claim facts, effective and efficient claim management, as well as communication of decisions both verbally and in writing to claimants and employers.

Requires independent decision making on less complex claims situations and some critical thinking. Claims analysis includes: eligibility determination for initial and ongoing benefits based on medical information received, contract analysis, customer service, fraud detection and awareness, financial calculations, interpreting medical and vocational information and adhering to all statutory / governmental regulations. This includes analyzing information received, and determining if additional information is required to make a benefits decision. Regularly communicates with employers, medical professionals (including physicians) and claimants.

WHAT YOU'LL DO:

  • Makes decisions in partnership with management throughout the life of the claim (initial adjudication and ongoing claims management) based upon claim facts, thorough evaluation and gathering of pertinent information to formulate appropriate action plans.
  • Develops case files that demonstrate appropriate decision making based on documented procedures using claim facts, pertinent policy provisions, customer expectations and special handling agreements.
  • Develops appropriate business relationships and communications with claimant, broker, sales organization, vendor partners, employer and internal partners (e.g. underwriting, legal, etc.). Communications demonstrate a solid level of customer service and professionalism that support the values of Mutual of Omaha.
  • Thoroughly documents all actions and rationales to ensure clear understanding of actions and ease of review.
  • Initiates regular and appropriate communication with claimants, employers and medical professional(s) throughout the life-cycle claims. This includes initial and ongoing claim decisions.
  • Reviews and determines continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions, and determining any changes in claim status or benefits. Requires interaction and coordination with internal and external partners including brokers, sales organization, clinical and physician resources, vocational experts, vendor partners and financial resources.
  • Accurately determines financial liability based on salary, other income sources, medical / vocational information and contract language. Has limited autonomy to approve initial and ongoing payments based upon holistic file evaluation. Responsible for accurate and timely transition of claims to the LTD organization.
  • Communicates changes in liability or claim status to claimants, policyholders, and appropriate Home Office departments.
  • Provides various reports to policyholders per contract requirements with a high level of customer service.
  • Determines eligibility based on contract language, payroll records, and other supporting documentation.
  • Adheres to ERISA and other federal/state laws concerning group disability insurance.
  • Demonstrates flexibility and ability to support unique customer requirements.
  • Creates written letters for the purpose of providing concise explanations to claimants regarding: claims determinations.
  • Remains abreast of industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures.

ABOUT YOU:

This position is multifaceted and diverse, requiring many different skill-sets in order to be effective including:

  • You help promote a culture of diversity and inclusion within the department and the larger organization. You value different ideas and opinions. You listen courageously and remain curious in all that you do.
  • You are able to work remotely and have access to high-speed internet.
  • Must be located in United States or Puerto Rico
  • Demonstrate a beginning level ability to analyze and interpret insurance provisions and contracts.
  • Ability to comprehend and apply insurance regulations to claim situations.
  • A solid level of customer service (written and verbal).
  • Ability to calculate disability benefits based on contract provisions and offset management.
  • Some knowledge / skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel.
  • Good organizational skills, attention to detail with a increasing degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency.
  • Ability to meet deadlines.
  • Ability to move from dependent to independent decision-making.
  • Ability to diffuse situations.
  • Ability to adapt to a changing environment.
  • Basic knowledge of medical terminology.
  • Analytical and decision-making skills.
  • Demonstrate the ability to increase independent decision making and critical thinking capabilities.
  • Good verbal and written communication skills.
  • Proficient with personal computer, Microsoft applications and Mutual of Omaha proprietary applications (ex. GSAP, Fineos).
  • Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.
  • Ability to manage claims on an ongoing basis, potentially for multi- year durations.
  • Fair, equitable, and consistent treatment of claims is necessary for accurate financial payments and policyholder retention and satisfaction.

VALUABLE EXPERIENCE:

  • College degree or equivalent industry experience
  • Previous STD/LTD claims processing skills/experience

WHAT WE CAN OFFER YOU:

  • A diverse workplace where associates feel a sense of belonging. To learn more about our commitment of Diversity, Equity and Inclusion, please visit our website
  • An organization that feels like a small, close-knit community and has the strength of a Fortune 300 company.
  • Tuition reimbursement, training and career development.
  • Comprehensive benefits plan that includes medical, dental, vision, disability and life insurance.
  • Flexible spending accounts for healthcare and childcare needs.
  • 401(k) plan with a 2% company contribution and 6% company match.
  • Competitive pay with an opportunity for incentives for all associates.
  • Flexible work schedules with a healthy amount of paid time off.
  • For more information regarding available benefits, please visit our Career Site.
  • Salary Range: Minimum: $19.50 MidPoint: $24.88 Maximum: $30.25
  • Pay commensurate with experience.
  • Recognized as a certified Great Place to Work®.

MUTUAL OF OMAHA:

Mutual of Omaha serves more than 4.8 million individual product customers and 39,000 employer groups. Our legacy of stability creates an environment where every associate is encouraged to experiment, innovate and grow in their own unique career path.

From day one, you’ll have the tools to be your best self at work. Here you’ll do meaningful work and your talents will have a positive impact on peoples’ lives as we help our customers protect what they care about and achieve their financial goals.

Each associate is a unique contributor to creating a diverse, dynamic, thriving and inclusive workplace. We want you to become engaged … feel a sense of belonging … and contribute to the company’s exceptional future.

We are committed to optimizing flexible work. We support a full range of work approaches: fully remote, hybrid and in-person. Many of our roles are remote. Employees in remote roles may occasionally travel to a Mutual of Omaha office or elsewhere for required meetings or team-building events. Remote employees who are assigned a Mutual of Omaha office location can work on-site on a voluntary basis, subject to local and company COVID-19 guidelines.

Join forces with a company that can AMPLIFY YOUR STRENGTHS AND EMPOWER YOUR CAREER.

For inquiries about the position or application process, contact our HR Helpline at 1-800-365-1405.

If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at 1-800-780-0304. We are available Monday through Friday 7 am to 4:30 pm CST we will reply within 24 hours.

Mutual of Omaha and its affiliates are an Equal Opportunity /Affirmative Action Employer. Qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. #circa#circa

To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.

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