Associate VB Claims Specialist

Job Posting End Date: August 14

About the role

This is an entry-level position within the Voluntary Benefits Claims Organization. The role is responsible for the thorough, fair, objective, and timely adjudication of voluntary benefits claims, providing technical expertise regarding applicable regulations. This position ensures excellent customer service and interacts regularly with employees, employers, health care providers, and other specialized internal resources.

Incumbents are considered trainees and are assigned a formal mentor for 6-12 months until assessed as capable of independent work. The role focuses on learning and developing skills, knowledge, and behaviors necessary to successfully adjudicate assigned claims in accordance with Unum’s claims philosophy and policies. Incumbents must demonstrate the ability to manage an assigned caseload, exercise discretion and independent judgment, and render timely claim decisions while providing strong customer service.

Minimum starting hourly rate is $25.00.

Responsibilities

• Maintain organizational service standards on all assigned claims, demonstrating success in developing and implementing effective strategies to manage a caseload of varying size and complexity.
• Develop an understanding and working knowledge of Voluntary Benefits for Unum and Colonial Life, including products, policies, procedures, and contracts.
• Understand applicable contract/policy definitions, provisions, clauses, exclusions, riders, waivers, and regulatory/statutory requirements for claim products administered.
• Develop skills to determine appropriate risk management strategies by analyzing and applying technical and complex contractual knowledge (policies and provisions) to ensure eligibility, liability decisions, and benefits payee.
• Develop problem-solving skills through analytical and logical thinking, resulting in the timely and accurate adjudication of simple to complex voluntary benefits claims.
• Gain working knowledge of systems needed for claims adjudication.
• Provide excellent customer service and independently respond to all inquiries within service guidelines.
• Ensure timely and accurate claims review, initiation and completion of appropriate claim validation activities, and referrals/notifications to other areas (e.g., medical assessments, billing).
• Produce objective, clear documentation and technical rationale for all claim determinations, ensuring compliance with Voluntary Benefits procedures and legal requirements, including state regulations.
• Partner and coordinate file strategies utilizing specialized resources, including nurses, physicians, vocational rehabilitation, and medical documentation assessment.
• Ensure a timely and well-communicated transfer process when transitioning integrated claims across lines of business, maintaining a coordinated claims experience for customers.
• Be familiar with specialized workflow requirements and performance standards for assigned customers.
• Perform other duties as assigned.

Requirements

• 4-year degree preferred or equivalent work experience.
• Ability to develop Voluntary Benefits product knowledge and apply a best-in-class service experience.
• Medical background, voluntary benefits claims, and/or disability management experience preferred.
• Strong analytical, critical thinking, and problem-solving skills.
• Ability to exercise independent judgment and discretion in increasingly complex claim adjudication decisions, including initial decisions and ongoing medical management.
• Able to effectively utilize a broad spectrum of resources, materials, and tools to assist with decision-making.
• Strong service and quality orientation.
• Ability to interact effectively and professionally with claimants, employers, medical resources, attorneys, accountants, brokers, and sales representatives.
• Demonstrated ability to operate with a sense of urgency and make balanced decisions with integrity and fairness.
• Excellent written and verbal communication skills.
• Meets the standards for this position as defined in the Talent Management framework.

Existing internal remote employees are eligible to apply.

Benefits

• Award-winning culture with inclusion and diversity as a priority.
• Performance-Based Incentive Plans.
• Competitive benefits package, including:
  • Health, Vision, and Dental coverage.
  • Short & Long-Term Disability.
  • Generous PTO, including paid time to volunteer.
  • Up to 9.5% 401(k) employer contribution.
  • Mental health support.
  • Career advancement opportunities.
  • Student loan repayment options.
  • Tuition reimbursement.
  • Flexible work environments.

All benefits are subject to the terms of their individual Plans.

Pay

The base salary range for this position is $40,000.00 - $75,600.00. Actual pay will be based on skill, geographical location, and experience. Additionally, Unum offers a portfolio of benefits, including healthcare, insurance, performance-based incentives, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution regardless of employee contribution.

About the company

Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland, and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA, plus over 35 U.S. field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.

With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of customers. Unum is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement without regard to race, color, religion, national origin, age, genetic information, military status, gender, sexual orientation, gender identity or expression, disability, or protected veteran status.