Description
SHIFT: Day Job
SCHEDULE: Full-time
Unit Specialist Dearborn, MI
Be part of an extraordinary team We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
PURPOSE: The Unit Specialist provides technical and support services to all claim personnel. Assists the supervisor in controlling the workflow of the unit and handles special project requests. The Unit Specialist deals with sensitive cases and technical questions on which claim personnel requires confirmation, additional information, or instruction; covers for claim load backup due to unusual volume, a shortage of claim personnel, or emergency situations; assures continuity of workflow by assisting in the day-today assignment and redistribution of case work. Handles the more complicated or sensitive telephone inquiries and correspondence.
DUTIES AND RESPONSIBILITIES:
Primary contact for Labor Relations and Plant medical and secondary for UAW Benefit Representatives.
Responsible for the review and handling of the daily pre-audit review and post feed error report and e-mail correspondence; OHSIM feed.
Other combined medical leave of absence related reports and processes
Performs claim audits as needed and mentors to ensure quality work in performed
Assist with training as needed
Functions as the lead to staff by providing technical expertise in the resolution of complex issues
Backup up for claim processing
Provides timely and accurate resolution of inquiries and issues regarding claim files completing research as needed.
Organizes and monitors daily processes for quality and timely completion.
Acts in the capacity of the supervisor in their absence in reference to workflow
Assists with Special Projects
Complete and distribute daily and weekly reports, provide guidance and monitor for compliance.
Process 4934s and related reports
Be able to make significant contribution to the claim's teams
Other duties as assigned
REPORT RESPONSIBILITIES
970 - ERISA Report - daily
144 - New Claim Report - daily
282 - 4934 Validation - weekly
617: ERISA denials
STD Hourly Lag reports - 14 day and 5-day lags
693: STD to LTD transition
712- CA claims (ensure offsets are taken) - weekly
738: ACS death notification - daily
Other reports as assigned
Qualifications
High School Diploma
Ability to functions as the lead to staff by providing technical expertise in the resolution of complex issues as they relate to claim processing
Ability to work well with people
Able to work without significant guidance.
Comprehensive knowledge of group insurance principles and practices with working knowledge of claim processing
Proficient contractual understanding of group Short Term Disability, Extended Disability Benefits and Long-Term Disability.
Computer Skills required
Excellent oral and written communication skills
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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state, and local laws.
Anthem, Inc. has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World's Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.antheminc.com. Anthem is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ability@icareerhelp.com for assistance.
REQNUMBER: PS71749-US
