Aflac

Customer Support

• Attend and actively participate in all scheduled Foundation training courses
• Receive monitored inbound calls, email, or chats regarding Aflac products and services
• Provide thorough and accurate responses to policy-holder requests and inquiries
• Maintain a position of trust and responsibility by keeping all policyholders confidential
• Perform other related duties as required

Customer Care Specialist

Implementation Specialist

• Accountable for end-to-end client onboarding for Life, Absence, and Disability Solutions, ensuring quality execution and timely delivery
• Establishes and sustains strong relationships with customers, brokers, and key partners
• Partners with executive leadership to anticipate demand and priorities
• Leads the development and enforcement of implementation strategies, standards, and best practices
• Drives innovation in implementation management, leveraging technology
• Promotes a high standard of customer experience
• Build and develop a high-performing team

AVP, Client Implementation

General

• Attends and participates in select customer meetings as appropriate to discuss feedback and/or needed process enhancements.
• Proactively identifies and surfaces customer and plan issues for resolution while acting as a liaison to communicate workflow results, ideas, and solutions.
• Manages escalated customer issues in conjunction with the Technical Leads, as applicable.
• Proactively analyses data, identifies trends and issues; provides system recommendations and designs feedback related to plan changes and updates.
• Works with IT to define system fixes, enhancements and requirements and performs user acceptance testing.
• Identifies process improvements for operations and leads process changes.
• Acts as main point of contact to report system issues to IT and tracks for resolution.
• Acts as a subject matter expert to assist customer and Account Executives (AE) in understanding the impacts of non-standard benefits and/or processes.
• Manage and prioritize ad hoc requests from Account Executives to support efficient execution and strategic focus on new and existing program opportunities.
• Provides customer process and/or tools training as needed.
• Identifies urgent business problems, obtains necessary information, accurately identifies root causes, and generates solutions.
• Initiates and maintains partnerships throughout the organization; encourages cooperation by promoting common goals and building trust.

Client Liaison

Manager

• Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards; handles the most complex claims from a clinical and financial perspective; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible
• Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claims team operational metrics
• Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimant's and employer's trust and confidence; anticipates customer’s needs and takes action as appropriate
• Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence
• Mentors and coaches new team members and participates in projects supporting the team's business initiatives
• Performs other related duties as required

Senior STD Case Manager

Claims Specialist

• Review and process Wellness, Accident, and Vision insurance claims
• Determine the nature and validity of claims by reviewing policy status and supporting documents
• Provide prompt customer service to policy holders and providers regarding claims
• Document phone calls and follow-up on claim issues
• Maintain databases and prepare information using software systems

Full-stack Engineer

• acts as a main point of contact for claims specific questions for the case managers
• serves as a mentor for new hires as well as supports new hiring training
• takes an active role in refresher training and development of existing staff
• ensures case managers are utilizing appropriate risk management skills to secure the appropriate claim outcome
• conducts manager reviews/audits of claims as necessary to ensure overall quality
• provides the appropriate coaching and feedback to case managers as needed
• monitors KPIs and reports to ensure service levels and commitments are met, working with case managers as needed
• monitors and adjusts workload balancing for case managers
• provides support to management in facilitating team meetings/ huddles
• may periodically manage complex cases and customer escalations
• elevates any trends and/or coaching opportunities to the leadership team
• completes special projects and/or ad hoc assignments as requested by leadership
• performs other related duties as required

Claims Technical Lead

Executive Assistant

• Organizes flow of work by reviewing correspondence and determining importance of such before distributing to executives or redirecting to the appropriate management team for feedback or response; answers questions and furnishes information to keep executive’s time free of minor detail work
• Prepares a variety of complex, sensitive, or routine correspondence on own initiative from drafts or verbal instruction, such as memos, letters, articles, reports, proposals, charts, etc.; prepares and processes routine forms, documents, requisitions, purchase orders, transmittal forms, etc., following standard procedures, and responds to inquiries
• Serves as a liaison between executives, managers, and visitors as required; reviews requests and schedules appointments; resolves problems requiring in-depth knowledge of company policies and procedures and projects in progress; receives, screens, and routes incoming telephone calls, places calls, receives visitors, arranges appointments, and maintains the executive calendar; coordinates travel arrangements and schedules meetings, prepares agendas and materials for presentations, and takes and prepares meeting minutes
• Maintains inventory levels of office supplies and initiates purchase orders as necessary; reconciles invoices and maintains current expense and balance records against budgeted dollars; provides administrative assistance to the management team by compiling data for and developing the department’s budget; submits travel and other expenses for payment or reimbursement
• Maintains effective and accurate filing systems that provide a quick reference database of records including, but not limited to, time sheets, statistical and financial reports that show the department’s accomplishments, productivity levels, operating cost, etc.; releases information according to company policies and procedures; audits files at specific intervals to identify and purge outdated or unnecessary items, and ensures confidentiality of records
• Provides administrative support related to the operational functions of the department and assists with the training and development of subordinate secretaries and other administrative staff
• Support leadership team through coordinating divisional/departmental meetings and events as well as supporting company events including Employee Appreciation Week, holiday celebrations, etc.
• Performs other duties as required.

• Reviews and processes Wellness and Hospital Indemnity insurance claims
• Determines the nature and validity of claims by reviewing policy status and patient eligibility
• Provides prompt customer service to policy holders, providers, and other internal company entities regarding claims
• Documents phone calls in the system and follows up on issues if needed
• Contacts insured or other appropriate persons to verify the accuracy and completeness of information on claims forms
• Performs other related duties as required

Consultant

• Reviews and evaluates appeal requests across STD, LTD, Life, PW, AD&D, TPA, statutory and voluntary benefit products for fully insured and ASO customers
• Conducts a complete review of claim files, medical documentation, policy information and related materials to support accurate and fair appeal decisions within required timeframes
• Ensures decisions comply with ERISA, state regulations and internal policies and procedures
• Performs research to clarify plan provisions, identify relevant information, and support case resolution
• Consults with medical directors, clinical resources, legal team members, other internal stakeholders, and contracted external resources to gather input for more complex cases
• Documents all findings, actions taken, and appeal determinations clearly and fully in the claim system to ensure proper audit and reporting practices
• Communicates appeal decisions in a clear and professional manner to claimants, employers, and other stakeholders
• Prioritizes and manages assigned workload to meet productivity, quality, and regulatory requirements
• Identifies cases requiring escalation based on complexity, risk, or unique circumstances
• Supports a positive customer experience by responding to questions and working collaboratively with internal partners
• Performs other related duties as required.

PLADS Appeals Consultant

• reviews and processes Wellness and Hospital Indemnity insurance claims based on information submitted by policy holders
• determines the nature and validity of claims by reviewing policy status, patient eligibility, and supporting medical and other documentation
• keys claims data while interpreting coding and medical terminology in relation to diagnoses and procedures
• uses multiple core administration databases, systems and subsystems to process and transmit claims for payment or further investigation
• provides prompt customer service to policy holders, providers and other internal company entities regarding claims
• documents phone calls in the system and follows-up on issues if needed
• contacts insured or other appropriate persons to verify the accuracy and completeness of information on claims forms and related documents
• responds to inquiries from policy holders, providers, agents regarding claim status and policy provisions
• provides back-up coverage for other teams as required
• maintains databases and prepares and extracts information using software systems
• performs various clerical duties as assigned, such as filing, photocopying, typing, maintaining databases and preparing and extracting information using software systems

Account Manager

• Manages a team of national account managers and account support staff focused on account relationships, stewardship, support; responsible for developing business plans for account retention, issue resolution, escalation management, and account support.
• Oversees the dedicated support team for accounts with enrollment services and solutions.
• Leverages business relations with internal partners to quickly resolve account concerns or questions.
• Coordinate with other departments to optimize overall account satisfaction; identify and track issues, conduct root cause analysis of persistent issues or sub optimal processes; develop solutions with partners to better support accounts.
• Oversees the development of quality controls; assists with reporting to ensure data integrity; assists with developing trigger reporting.
• Serves as an account management subject matter expert to internal/external stakeholders by leveraging an advanced understanding and expertise of products, services & technology.
• Collaborates with internal stakeholders on RFPs and go to market strategy.
• Manages and collaborates with each operational area to ensure overall organization growth and success.
• Develops and manages budget forecasting, manage hiring activities, team goal setting, semi-annual team assessment and calibration activities, and renewal/retention planning.
• Develops the department’s key activities to ensure adherence to training expectations; develops training strategies to help the department stay abreast of best practices.
• Coordinates strategic project initiatives and process reviews; ensures successful delivery of project expectations, including, but not limited to timeliness of completion, adherence to budgetary constraints, establishment of clear objectives, and facilitation of group discussion and decision making.
• Stays abreast of current trends and best practices in customer service, development, functional operations, and technology; directs, maintains control, and appraises performance of all operational functions for the department; maintains appropriate communications within area of responsibility, advising division senior management accordingly.
• Performs other duties as required.

Senior Manager, Account Management

Sales

• Supports key activities for the National Sales Executives through collaborative discussion for developing prospect sales strategies
• Stays abreast of the team’s needs by working with various internal and external partners
• Assists with national sales opportunities including presenting offerings to clients and brokers, managing the RFP process, and account implementations
• Coordinates with Premier Broker team to solve escalations for brokers and/or clients
• Assists with managing the new case pipeline
• Ensures teams collaborate when new opportunities arise
• Partners with internal teams to refine the RFP process

Senior Consultant, National Sales

• Makes timely, accurate, and customer-focused STD and AM new and ongoing claim decisions using advanced independent discretion guided by company procedures and regulatory standards
• Handles the most complex claims from a clinical and financial perspective
• Reaches out to obtain relevant clinical, vocational, employer, financial, and other information
• Compares the information to the terms, limitations, and conditions of the contract and renders the claim decision as quickly as possible
• Documents the claims system in an accurate and comprehensive manner
• Prepares, updates, and utilizes a claims management plan to attain the most appropriate outcome
• Remains in full compliance with regulatory requirements
• Maintains a superior level of genuine caring and empathetic customer service throughout all interactions
• Works with internal partners to support flexibility, collaboration, and creating a positive work environment
• Mentors and coaches new team members and participates in projects supporting the team's business initiatives