Description
SHIFT: Day Job
SCHEDULE: Full-time
Approver Sr. Dearborn, MI 48120
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?
The Disability Care Coordinator/Senior Approver (Union Role) -DCC is responsible for the management of Disability claims for group policy holders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.
Duties and Responsibilities:
Responsible for adjudicating all STD claims in a timely manner
Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language
Providing excellent customer service
Gather clinical and confirm eligibility information to verify approved period of disability
Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim
Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management
Ability to interact with treating sources to negotiate appropriate treatment plan and return to works
Responsible for timely and accurate payment of Disability claims
Ability to determine and withhold FICA, Federal and State Levies
Determine and calculate appropriate offsets
Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation, and other vendors to obtain claim information
Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee
General claims support duties to include telephone coverage
Other duties as assigned
Qualifications
High School Diploma
Preferred: BA and/or equivalent work experience
Comprehensive knowledge of group insurance principles and practices
Proficient contractual understanding of group Disability product
Basic computing and keyboarding skills required with proficiency in Word and Excel
Excellent oral and written communication skills including active listening
Ability to make timely and effective decisions
Ability to work independently as well as working effectively in a team environment
Knowledge/Experience:
Provides superior, professional, and courteous service to our customers
Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts
Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up
Conducts research and resolves issues
Participates in specials projects assigned
Demonstrates full competence in own work area
Makes significant contribution to work team
Performs other duties as assigned
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: PS74351-US
