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Appeals Specialist

AFLAC locationColumbus, GA
29 positions

Web Mktg Technology Specialist

AFLAC locationColumbus, GA
29 positions
info linkReport a probelm Originally Posted : February 11, 2021 | Expires : March 13, 2021


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Job Location
Columbus, GA, United States


Position Summary

The Company

Aflac Inc.


The Division

Aflac / Premier Life, Absence & Disability


The Location



Reviews and recommends a course of action on claims elevated after denial of payment; analyzes claims received as a result of volatile, denied, urgent, etc., situations; performs research and analysis to resolve escalated and complex issues relating to claims filed in compliance with insurance laws and regulations


Responsibilities (Principal Duties and Responsibilities)


Reviews, investigates, and evaluates appeals from all lines of business including STD, LTD, Life, PW, ADD, TPA, and Voluntary Products for Fully Insured and Administrative Services Only customers


Completes independent, full, and fair appeal decisions based on Plan/Policy language in a timely manner


Abides by all insurance laws and regulations


Conducts pertinent research to evaluate and respond to appeals


Consults with medical director or obtains independent medical reviews on cases as required by ERISA


Provides timely and detailed appeal determination to the claimant and employer


Performs other related duties as required


Qualifications (Education & Experience and Job Knowledge & Skills)


Education & Experience

Bachelors Degree in Healthcare, Business, or a related field and 10 or more years of combined experience handling appeals from STD, LTD, Life, PW, ADD, TPA, and Voluntary Products for Fully Insured and Administrative Services Only customers, or an equivalent combination of education and experience


Job Knowledge & Skills

Proficient in ERISA regulations including 2018 regulatory changes/requirements


Excellent organization, written and oral communication skills


Experience using MS Office Suite -Word, Excel, and PowerPoint


Excellent presentation and negotiating skills


Advanced skills and comprehensive knowledge of the principles, concepts, practices, and procedures to process claims


Extensive knowledge of all aspects of PLADS products and procedures, policy data, benefit plans, company terminology, medical terminology, and in-house coding systems


Organizational Competencies

Acting with Integrity, Communicating Effectively, Pursuing Self-Development, Serving Customers, Supporting Change, Supporting Organizational Goals, Working with Diverse Populations


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