Aflac

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

Claims Specialist

• 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

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 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

Senior STD Case Manager

Analyst

• Provides support to less experienced team members, providing guidance in preparing deliverables, verifying accuracy, and resolving technical issues.
• Executes payment processing, including tax-related transactions, and performs reconciliations across systems.
• Apply established procedures to independently complete routine and moderately complex work with minimal guidance.
• Assists with team knowledge sharing and onboarding support to promote consistency and efficiency.
• Identifies process gaps, supports workflow improvements, and change initiatives.
• Partners with internal teams to resolve customer issues and support service delivery.
• Researches and resolves client accounting and tax-related issues; identifies root causes and implements solutions within defined guidelines.
• Performs non-routine and some routine tasks; resolves most issues independently and escalates more complex matters as needed.
• Reconciles disability, absence and statutory payments for moderately complex accounts; reviews for discrepancies and ensures accuracy.
• Analyze account activity, customer requests, invoices, and payment history to determine appropriate actions.
• Prepares journal entries and supports ongoing transaction accuracy.
• Ensures accuracy of tax reporting and support responses to standard inquiries (e.g., W-2s, 1099s).
• Communicate with internal partners and external contacts to obtain information and resolve issues.
• Participate in team or client discussions as needed to support issue resolution and process improvements.

Senior Client Account Analyst

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
• 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 – PLADS STD, Integrated Claims

Operations

• Maintain accurate departmental and case records; set up incoming request to support team specific functions
• Review files for accuracy, initiate follow-up communications to obtain outstanding documentation, and forward completed files for further processing
• Input case documentation into internal systems, performing verification checks for accuracy, consistency, and completeness
• Performs general clerical and office support tasks, such as document reproduction, preparation, organizing, and archiving
• Compile data, maintain related files and provide administrative support to the assigned team/department
• Complete searches and process undeliverable mail, including uploading and tracking relevant documentation
• Handle standard inquiries, resolve issues, and provide follow-up to ensure completion
• Process and reconcile expenses, prepare reports, identify discrepancies, and maintain various databases, if applicable
• Develop and maintain a strong working knowledge of departmental systems, administrative procedures, vendor requirements, and workflow protocols

Operations Support Coordinator

• Manages the daily operations of the Claims business unit
• Gathers and analyzes data and reports that pertain to the overall operation of the Claims business unit
• Develops solutions and implements actions to resolve problems and ensure customer satisfaction
• Directs efforts to implement risk management and quality improvement initiatives
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• Identifies, analyzes, and monitors business technology requirements and enhancement possibilities
• Monitors and controls operating expenses

Manager, Claims Operations – PLADS Leave of Absence

• 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.

• Supports the development and execution of enrollment and re-enrollment growth strategies across products and distribution channels
• Collaborates with sales and service teams to drive enrollment initiatives and improve customer engagement outcomes
• Assist in the creation of enrollment materials, communications, and project deliverables to support campaigns and ongoing initiatives
• Assist with analyzing in-force book of business to identify opportunities for growth retention, and improved participation
• Supports cross-functional discussions, including underwriting and operational partners, to advance customer growth strategies
• Develops and positions customer-facing communications to effectively convey value propositions and enrollment solutions
• Participates in customer meetings to support engagement strategies and deliver educational content tailored to audience needs
• Tracks and manages project activities, deliverables, and results to support reporting and yearover- year performance insights
• Utilizes data and insights to support campaign development and inform future enrollment strategies
• Performs other duties as required

Enrollment Consultant

• Manages the daily operations of the Claims business unit
• Gathers and analyzes data and reports that pertain to the overall operation of the Claims business unit
• Assists in strategic and tactical operational plans to ensure achievement of company and departmental goals
• Develops solutions and implements actions to resolve problems and ensure customer satisfaction
• Reviews processes and procedures to streamline activities to enhance service turnaround time, productivity, and quality
• Directs efforts to implement risk management and quality improvement initiatives
• Coordinates and monitors training efforts to ensure that necessary education tools are provided to employees
• Identifies, analyzes, and monitors business technology requirements and enhancement possibilities

Manager, Claims Operations

Business Analyst

• Performs work for multiple business segments; supports moderate to highly complex business processes.
• Serves as a team member for projects of moderate to large scope and moderate to high complexity.
• Assists with project deliverables such as project initiation requests, business and technical requirements, use cases, interface specifications, business architecture models, cost/benefit analysis, risk and issue logs, test plans, training plans and elevation / validation plans.
• Provides technical solutions to meet user needs, manages business unit expectations and maintains established business relationships.
• Communicates and presents moderately complex technical concepts simply and effectively to nontechnical team members
• Collects, analyzes, and documents business and technical requirements.
• Assesses long term needs, performs gap analysis and makes future state recommendations.
• Participates in JAD (Joint Application Design) sessions with business partners to enable technical solutions that allow for process improvements.
• Owns project deliverables/artifacts, works in a self-directed environment to develop artifacts.
• Conducts systems analysis with a focus on technical process models and use cases.
• Provides testing support and analysis for defect resolution.
• Performs other related duties as required.

Business Analyst – Configuration

Auditor

• Serves as a resource for less experienced team members using broad knowledge, experience, and accomplishments to assist in the attainment of department goals
• Audits, monitors, coaches, and evaluates the quality of service provided by lower-level team members
• Reviews audit findings; assists with analyzing audit data before quality auditor sends report to business unit
• Identifies, documents, and updates administrative rules
• Works with management to develop and maintain efficient work processes
• Reviews procedures/processes and recommends enhancements as needed
• Performs research related to SOX and other regulatory requirements for audits and prepares audit responses
• Leads audit initiatives

Senior Quality Auditor – PLADS Policy Contracts

Strategy

• Leads the team to deliver the products needed within the coverage strategy of the Line of Business (LoB) as originally developed.
• Manages the Product Development and Management process from beginning to end, serving as a trusted advisor between Product, Underwriting, Corporate Law, Claims Legal, Regulatory Affairs and the Business Units (BU) and other Service Support Units.
• May act as project manager for larger projects; leads the development of detailed work plans, schedules, resource plans, and status reports.
• Understands and facilitates implementation of the Product Strategy.
• Oversees projects from original concept through final implementation within the Product Development/Management Process Scope.
• In collaboration with others, translates product specifications to fit technology and systems.
• Ensures that all assigned projects are completed within agreed-upon time frames.
• Participates in the development, implementation, and institutionalization of standard practices around project execution and change management.
• Recommends changes to policies, systems, products/ services to leaders.
• Ensures required documentation, implementation activities, and communications are completed for established policies, procedures and operating standards related to assigned products and other related solutions.
• Regularly monitors and evaluates activities to identify potential risks and issues of noncompliance.
• Participates or may lead risk assessments for assigned products and escalates potential issues to higher management.
• Performs other related duties as required.

PLADS Appeals Consultant

Claims Specialist

Senior Manager, Account Management

Senior Consultant, National Sales

Senior STD Case Manager

Senior Client Account Analyst

Claims Technical Lead – PLADS STD, Integrated Claims

Operations Support Coordinator

Manager, Claims Operations – PLADS Leave of Absence

Claims Technical Lead – PLADS STD, Integrated Claims

Enrollment Consultant

Manager, Claims Operations

Business Analyst – Configuration

Senior Quality Auditor – PLADS Policy Contracts

Product Strategy Lead – Group AD&D, Life Products