Anthem, Inc. Integrated Absence and Disability Claims Case Manager in Atlanta, Georgia
SHIFT: Day Job
Due to the current COVID-19 (coronavirus) pandemic, this position will require you to work remotely from your home with the expectation that you will return to a regular, in-office work environment. As we continue to monitor guidance from CDC and state officials there may be times you would need to report to the office on a monthly or quarterly basis for team meetings or engagement activities.
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 care companies and a Fortune Top 50 Company.
Responsible for reviewing, investigating and documenting Integrated Short Term Disability (STD), Statutory Paid Family Leave and FMLA claims to determine eligibility for benefits. Primary duties may include, but are not limited to:
Reviews claim materials against disability policy coverage and duration guidelines to determine liability and adjudicates the claim.
Gathers clinical and eligibility information to verify approved period of disability.
Provides policyholder relationship management.
Advises policyholders on coordination between Paid Family Leave, FMLA, Statutory Benefits.
Ensures compliance with all federal and state leave laws.
Oversees coordination of ADA management within the FMLA/Disability claim.
Works with Disability Case Management Nurses and Physician Reviewers to review complex/questionable claims.
Maintains up-to-date knowledge of company products and services.
Knowledge of ERISA, Fair Claims Practices Model Act, privacy regulations, punitive damages statues and state and federal laws governing group insurance.
Administers disability income payments on behalf of group policyholders.
Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering.
Performs calculations for adjustments for Social Security and Workers Compensation awards.
Mails appropriate State program forms to employees.
Requires a High School diploma or GED; 2 years of experience in Disability and/or Absence/Paid Family Leave Case Management, up to 2 years experience in claims or customer service preferably in the managed care or healthcare insurance industry; or any combination of education and experience, which would provide an equivalent background.
BA/BS degree preferred.
Certification in FMLA, ADA, and/or PFL desired.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.