Your Talent. Our Vision. At Anthem, Inc., it's a powerful combination, and the foundation upon which we're creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we will drive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Responsible for investigating and documenting Long Term Disability (LTD) claims for group policyholders. Typically handles complex, fully insured claims to ensure appropriate risk management.
Primary duties may include, but are not limited to:
Administers disability income payments on behalf of group policyholders.
Gathers clinical and eligibility information to verify approved period of disability.
Reviews claim materials against LTD disability policy coverage.
Determines liability and adjudicates the claim.
Works with Disability Management nurses, Vocational Rehabilitation Counselors, and Physician Reviewers to review complex/questionable claims and determine appropriate claim outcomes.
Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
Identifies claims with opportunity for enhanced risk management and coordination of Clinical and Vocational Resources.
Reviews and audits ongoing disability claims to determine continued liability for the company.
Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering.
Handles complex cases/calculations referred from the DCM I's and II's.
Administers payments on a monthly basis.
Performs calculations for adjustments for Social Security and Workers Compensation awards.
Coordinates settlements on appropriate claims
Provides reporting and trending on LTD Audits, making recommendations to increase risk management acumen in STD and LTD.
Provides feedback, coaching and development of STD and LTD DCMs to appropriate Managers
Requires a BA/BS; 3 years' experience in Disability Claims, or any combination of education and experience, which would provide an equivalent background.
Anthem, Inc. is ranked as one of America's Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.