Atlanta, Georgia

Description

SHIFT: Day Job

SCHEDULE: Full-time

Responsibilities:

Responsible for reviewing, investigating and documenting Integrated Short Term Disability (STD), Statutory Paid Family Leave and FMLA claims to determine eligibility for benefits.

Primary duties may include, but are not limited to:

  • Reviews claim materials against disability policy coverage and duration guidelines to determine liability and adjudicates the claim.
  • Gathers clinical and eligibility information to verify approved period of disability.
  • Provides policyholder relationship management.
  • Advises policyholders on coordination between Paid Family Leave, FMLA, Statutory Benefits.
  • Ensures compliance with all federal and state leave laws.
  • Oversees coordination of ADA management within the FMLA/Disability claim.
  • Works with Disability Case Management Nurses and Physician Reviewers to review complex/questionable claims.
  • Maintains up-to-date knowledge of company products and services.
  • Knowledge of ERISA, Fair Claims Practices Model Act, privacy regulations, punitive damages statues and state and federal laws governing group insurance.
  • Administers disability income payments on behalf of group policyholders.
  • Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
  • Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering.
  • Performs calculations for adjustments for Social Security and Workers Compensation awards.
  • Mails appropriate State program forms to employees.

Qualifications

Minimum Requirements:

  • Requires a High School diploma or GED; 2 years of experience in Disability and/or Absence/Paid Family Leave Case Management, up to 2 years experience in claims or customer service preferably in the managed care or healthcare insurance industry; or any combination of education and experience, which would provide an equivalent background.

Pefsrerred Qualification:

  • BA/BS degree preferred.
  • Certification in FMLA, ADA, and/or PFL desired.


We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Atlanta, Georgia

If you’re a reserve or veteran member of the military, we foster a welcoming environment that’s dedicated to honoring your service and helping you achieve your career goals. Veterans of Anthem — one of our Business Resource Groups — partners with our Talent Acquisition teams to maximize career offerings for you and your family members, striving to help you transition to civilian service and grow your career at the same time. 

Join Anthem's Military and Veteran Talent Network: https://anthemcareers.ttcportals.com/pages/military 

WE ARE HIRING

Anthem, Inc. is currently seeking military veterans and military spouses with operations experience.  Whether your experience is hands-on as an operational specialist or in operational leadership, Anthem wants to have an impact on your career and professional growth by speaking with you about their career opportunities.

If you are interested in learning more, check out Anthem's current open positions to the right for more information and to apply today!

Not sure where to start?  Send RecruitMilitary Success Manager, Taylor Groves, your questions at taylor.groves@recruitmilitary.com 

 

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