Appeals Consultant

Salary Range: $57,000 - $145,000

Job Posting End Date: September 19, 2024

We’ve Got You Under Our Wing

We are the duck. We develop and empower our people, cultivate relationships, give back to our community, and celebrate every success along the way. We do it all…The Aflac Way.

Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands. Aflac has been recognized as Fortune’s 50 Best Workplaces for Diversity and as one of World’s Most Ethical Companies by Ethisphere.com.

Our business is about being there for people in need. So, ask yourself, are you the duck? If so, there’s a home, and a flourishing career for you at Aflac.

Worker Designation – This role is designated as a remote role. You will be expected to work from your home, within the continental US. Although this role is designated as remote, there may be occasions that you are requested to come to the office based on business need. Any requests to come to the office would be communicated with you in advance.

What does it take to be successful at Aflac?

• Acting with Integrity
• Communicating Effectively
• Pursuing Self-Development
• Serving Customers
• Supporting Change
• Supporting Organizational Goals
• Working with Diverse Populations

What does it take to be successful in this role?

• Proficient in ERISA regulations including 2018 regulatory changes/requirements

• Excellent organization, written and oral communication skills

• Experience using MS Office Suite -Word, Excel, and PowerPoint

• Excellent presentation and negotiating skills

• Advanced skills and comprehensive knowledge of the principles, concepts, practices, and procedures to process claims

• Extensive knowledge of all aspects of PLADS products and procedures, policy data, benefit plans, company terminology, medical terminology, and in-house coding systems

Education & Experience Required

• Bachelor's Degree In healthcare, business, or a related field
• Five years of combined experience handling appeals from STD, LTD, Life, PW, ADD, TPA, and Voluntary Products for Fully Insured and Administrative Services Only customers

Or an equivalent combination of education and experience

Travel

Less than or equal to 10%

Principal Duties & Responsibilities

• Reviews, investigates, and evaluates appeals from all lines of business including STD, LTD, Life, PW, ADD, TPA, and Voluntary Products for Fully Insured and Administrative Services Only customers

• Completes independent, full, and fair appeal decisions based on Plan/Policy language in a timely manner

• Abides by all insurance laws and regulations

• Conducts pertinent research to evaluate and respond to appeals

• Consults with medical director or obtains independent medical reviews on cases as required by ERISA

• Provides timely and detailed appeal determination to the claimant and employer

• Performs other related duties as required

Total Rewards

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions including, but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. The range has been created in good faith based on information known to Aflac at the time of the posting.  Compensation decisions are dependent on the circumstances of each case. This salary range does not include any potential incentive pay or benefits, however, such information will be provided separately when appropriate. The salary range for this position is $57,000 to $145,000

In addition to the base salary, we offer an array of benefits to meet your needs including medical, dental, and vision coverage, prescription drug coverage, health care flexible spending, dependent care flexible spending, Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee), 401(k) plans, annual bonuses, and an opportunity to purchase company stock.  On an annual basis, you’ll also be offered 11 paid holidays, up to 20 days PTO to be used for any reason, and, if eligible, state mandated sick leave (Washington employees accrue 1 hour sick leave for every 40 hours worked) and other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being. Aflac complies with all applicable leave laws, including, but not limited to sick and safe leave, and adoption and parental leave, in all states and localities.