Lead Appeals Specialist
Company: Unum
Location: Chattanooga
Posted on: August 7, 2022
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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
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