Lead Appeals Specialist

Company: Unum
Location: Chattanooga
Posted on: August 7, 2022

Job Description:

Job Posting End Date: August 11 Unum is a company of people serving people. As one of the world's leading employee benefits providers and a Fortune 500 company, Unum's financial protection benefits help protect more than 36 million working people and their families from the financial impact of illness or injury. Unum's two distinct, but similarly focused US businesses - Unum US and Colonial Life - are each a market leader in making disability, life, accident, critical illness, dental, and vision insurance accessible in the workplace. Headquartered in Chattanooga, Tennessee, Unum also has significant US operations in Portland, Maine and Baton Rouge, Louisiana - and over 35 field offices nationwide. Colonial Life is headquartered in Columbia, South Carolina with over 40 field offices nationwide. General Summary: Job Description Principal Duties and Responsibilities Manage and oversee caseload of appeals of ERISA and non-ERISA claims on multiple product lines within established timeliness and productivity standards with appropriate validation. Ensure sound, impartial appeal decisions according to the contract based on the de novo review of medical, vocational, and legal facts of the claim. Utilize appropriate resources, as needed, to arrive at thorough, fair, and objective appeal decisions. Ensure compliance with ERISA and other regulatory standards, as applicable. Develop Skills in identifying and recommending alternative appeals resolutions as appropriate. Make balanced decisions and provide creative solutions with the highest degree of integrity and fairness. Implement and interpret management policies and operating practices. Ensure timely appeal decisions. Ability to develop communication skills to effectively represent and defend the Company's position as the authoritative corporate representative in litigation. Establish and maintain extensive contact and communications with claimants, policyholders, physicians, attorneys, and other resources (internal and external), while managing the conflict that may arise in the claim. Share feedback to Operations personnel on specific claim appeal decisions. Extensive interaction with Operations, Complaints, Medical, Vocational, Legal, Audit, Sales Office, Policyholders, Claimants and Claimant's Counsel. Ability to effectively balance the quality and productivity expectations set by the Appeals department. May perform other duties as assigned. Job Specifications 4 year degree strongly preferred. 4 years of claims experience required. IDI or LTD claims experience strongly preferred. Demonstrated technical ability combined with strong decision and analytical skills. Capable of high level understanding of regulatory and legal requirements and ability to manage appeals in accordance with company standards for compliance with those requirements. Capable of effectively communicating and defending the Company's position as the authoritative corporate representative in a demanding litigation setting. Capable of handling high volumes of appeals in a timely manner, meeting regulatory frameworks and company guidelines. Capable of working independently and exercising discretion. Ability to manage and prioritize diverse kinds of activities. Position could be filled as a Senior Appeals Specialist dependent on experience Our company is built on helping individuals and families, and this starts with our employees. We want employees to maintain a positive balance, which is why we provide access to the benefits and resources they need to invest in themselves. From our onsite fitness facilities and generous paid time off to employee professional development programs, we are committed to helping employees live and work their best - both inside and outside the office. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person's race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status. Company: Unum

Keywords: Unum, Chattanooga , Lead Appeals Specialist, Other , Chattanooga, Tennessee