Appeals Specialist/Sr. Appeals Specialist (Workplace Solutions) Omaha, NE or Chattanooga, TN
Job no: 497608
Work type: Full Time Regular
Location: Nebraska, Tennessee
Categories: Customer Service, Claims/Claims Processing
|Under general supervision, this position will apply knowledge and experience while evaluating that appeal criteria is met. Responsible for applying analytical thought to review end to end appeals assessments, and compose effective arguments utilizing contractual language to support reconsideration. Responsible for composing effective written communication to summarize the appeals request, status and decision determination.
WHAT YOU'LL DO:
- Reviews all information submitted, both pre and post adverse benefit determination, for Group STD, LTD, Life, AD&D, Waiver of Premium, CI and Accident appeals. Overcomes objections that prevent payment of a claim through effective appeal arguments and has judgement to escalate as appropriate. Requests submission of additional information to clarify issues as necessary.
- Renders decisions on claim appeals utilizing risk management resources (i.e., medical, vocational, legal resources). Guides client appeal activities, advising and serving as a technical expert. Ability to leverage contract language to support decisions.
- Composes effective, efficient and professional written communications to claimants, their representatives, group policyholders, brokers and attorneys. Documents all actions in a clear concise manner. Maintains accurate records of cause / origin, disposition, and trending of appeals.
- Adheres to ERISA and other federal/state laws concerning group insurance.
- Researches and evaluates emerging Federal Common laws, Circuit & District level case laws and the impacts on group disability appeals. Remains current on Company and industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures. Presents cases to the appeals committee, responding to questions and obtaining additional information as requested.
- Actively seeks out opportunities for technological advancements and enhancements of procedures and efficiency of process. Mentors, coaches and trains claims staff and clients regarding the appeals process, procedures and related risk management issues.
- 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.
- Through understanding of claims adjudication, benefit determination, investigation, file development, legal requirements, and contract interpretation.
- Ability to de-escalate situations on a regular basis.
- Works with the Law Division on legal matters and may participate in depositions or trials.
- Ability to conduct focused and extensive research on claims situations.
- Superior attention to detail.
- Ability to work independently and in a team environment.
- Excellent communication skills, with the ability to be pleasant and professional during interactions with co-workers, clients, claimants, vendors and others.
- Ability to conduct small group presentations.
- Strong mathematical, analytical, problem solving and decision-making skills.
- Strong persuasion and negotiation skills. Ability to interpret and communicate disability contract language.
- Demonstrated high-level risk management skills.
- Flexibility to manage multiple tasks simultaneously. Ability to initiate and prioritize regular work duties and projects.
- Strong computer skills, proficient in PC environment and MS Word, Excel and Outlook.
- Ability to act as mentor, coach, trainer to claims staff and clients regarding the appeals process, settlement procedures and related risk management issues.
- Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations.
- Minimum 5-7 years work experience managing group short term and or long term disability claims with consistently meeting all job expectations.
WHAT WE CAN OFFER YOU:
- A diverse workplace where associates feel a sense of belonging
- An organization that feels like a small, close-knit community and has the strength of a Fortune 500 company
- Tuition reimbursement, training and career development
- Competitive salary, incentives, 401(k), flexible work schedules and a healthy amount of time off
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.
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.
To All Recruitment Agencies: We do not accept unsolicited agency resumes and we are not responsible for any fees related to unsolicited resumes.
Advertised: Central Standard Time
Applications close: Central Standard Time
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