Anthem, Inc. Integrated Absence/Disability Claims Case Mgr Sr in Atlanta, Georgia
SHIFT: Day Job
Your Talent. Our Vision. At Anthem, Inc., it’s a powerful combination, and the foundation upon which we’re creating greater access to 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 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.
Qualifications - External Minimum Requirements:
Requires a BA/BS degree and a minimum of 4 years of experience in Disability and Absence/Paid Family Leave Case Management; or any combination of education and experience which would provide an equivalent background. Preferred Qualification: 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.
The health of our associates and communities is a top priority for Anthem. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide - and Anthem approves - a valid religious or medical explanation as to why you are not able to get vaccinated that Anthem is able to reasonably accommodate. Anthem will also follow all relevant federal, state and local laws. 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.