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. You will interact regularly with employees, employers, healthcare providers, and internal resources while delivering excellent customer service. Incumbents are considered trainees and are assigned a formal mentor for 6-12 months until assessed as capable of independent work. The minimum starting hourly rate is $25.00.

Responsibilities

• Maintain organizational service standards on all assigned claims by 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.
• Determine appropriate risk management strategies by analyzing and applying technical and complex contractual knowledge to ensure eligibility, liability decisions, and benefits payee.
• Develop problem-solving skills through analytical and logical thinking to adjudicate a variety of simple to complex voluntary benefits claims accurately and timely.
• 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 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 while ensuring compliance with procedures and legal requirements, including state regulations.
• Partner and coordinate file strategies using specialized resources such as nurses, physicians, and vocational rehabilitation when assessing medical documentation.
• Ensure a timely and well-communicated transfer process for integrated claims across lines of business, maintaining a continuous 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 the decision-making process.
• 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.

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- and long-term disability insurance.
  • 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. Unum offers a portfolio of benefits and rewards, including healthcare benefits, insurance benefits, performance-based incentive plans, 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 is a Fortune 500 company and a leading provider of employee benefits to companies worldwide. With 10,000 employees helping over 39 million people globally, every role at Unum is meaningful and impacts customers' lives. Headquartered in Chattanooga, TN, Unum has international offices in Ireland, Poland, and the UK, with significant operations in Portland, ME, and Baton Rouge, LA. Colonial Life, part of Unum Group, is headquartered in Columbia, SC, with over 40 field offices nationwide.