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Appeals Specialist

AFLAC locationColumbus, GA
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29 positions
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Web Mktg Technology Specialist

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

Details

Salary
Unspecified
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Job Location
Columbus, GA, United States

Description

Position Summary

The Company

Aflac Inc.

 

The Division

Aflac / Premier Life, Absence & Disability

 

The Location

Remote

 

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

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

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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