Paid Family Medical Leave Benefit Claim Specialist/Sr. (Workplace Solutions)
Company: Mutual of Omaha
Posted on: September 9, 2020
Ensures the accurate, prompt and thorough evaluation and
management of disability claims by analyzing and determining the
appropriate action steps while adhering to both internal and
external regulations and ensuring an industry leading customer
experience. This role has direct impact on the success of BSD from
both a financial and persistency (customer retention) perspective.
WHAT YOU'LL DO:
- Makes decisions in partnership with management throughout the
life of the claim (initial adjudication and ongoing claims
management) based upon claim facts, thorough evaluation and
gathering of pertinent information to formulate appropriate action
- Develops case files that demonstrate appropriate decision
making based on documented procedures using claim facts, pertinent
policy provisions, customer expectations and special handling
- Develops appropriate business relationships and communications
with claimant, broker, sales organization, vendor partners,
employer and internal partners (e.g. underwriting, legal, etc.).
Communications demonstrate a solid level of customer service and
professionalism that support the values of Mutual of
- Thoroughly documents all actions and rationales to ensure clear
understanding of actions and ease of review.
- Initiates regular and appropriate communication with claimants,
employers and medical professional(s) throughout the life-cycle
claims. This includes initial and ongoing claim decisions.
- Reviews and determines continuing claim liability, which
includes evaluating and obtaining claim documentation, resolving
questions, and determining any changes in claim status or benefits.
Requires interaction and coordination with internal and external
partners including brokers, sales organization, clinical and
physician resources, vocational experts, vendor partners and
- Accurately determines financial liability based on salary,
other income sources, medical / vocational information and contract
language. Has limited autonomy to approve initial and ongoing
payments based upon holistic file evaluation. Responsible for
accurate and timely transition of claims to the LTD
- Communicates changes in liability or claim status to claimants,
policyholders, and appropriate Home Office departments.
- Provides various reports to policyholders per contract
requirements with a high level of customer service.
- Determines eligibility based on contract language, payroll
records, and other supporting documentation.
- Adheres to ERISA and other federal/state laws concerning group
- Demonstrates flexibility and ability to support unique customer
- Creates written letters for the purpose of providing concise
explanations to claimants regarding: claims
- Remains abreast of industry changes, federal and state
legislation and regulations, as well as changes in internal
processes and procedures.
This position is multifaceted and diverse, requiring many different
skill-sets in order to be effective including:
- Demonstrate a beginning level ability to analyze and interpret
insurance provisions and contracts.
- Ability to comprehend and apply insurance regulations to claim
- A solid level of customer service (written and
- Ability to calculate disability benefits based on contract
provisions and offset management.
- Some knowledge / skill in presentation, electronic mail, data
entry, plus PC knowledge to include various software packages, e.g.
- Good organizational skills, attention to detail with a
increasing degree of accuracy, and the ability to work somewhat
independently and apply a sense of urgency.
- Ability to meet deadlines.
- Ability to move from dependent to independent
- Ability to diffuse situations.
- Ability to adapt to a changing environment.
- Basic knowledge of medical terminology.
- Analytical and decision-making skills.
- Demonstrate the ability to increase independent decision making
and critical thinking capabilities.
- Good verbal and written communication skills.
- Proficient with personal computer, Microsoft applications and
Mutual of Omaha proprietary applications (ex. GSAP,
- Ability to maintain regular and predictable attendance in
adherence to department and company attendance
- Ability to manage claims on an ongoing basis, potentially for
multi- year durations.
- Fair, equitable, and consistent treatment of claims is
necessary for accurate financial payments and policyholder
retention and satisfaction.
- You help promote a culture of diversity and inclusion within
the department and the larger organization. You value different
ideas and opinions. You listen courageously and remain curious in
all that you do.
- You are able to work remotely and have access to high-speed
- Paid Family Medical Leave claims processing
- College degree or equivalent industry experience
WHAT WE CAN OFFER YOU:
- A diverse workplace where associates feel a sense of
- An organization that feels like a small, close-knit community
and has the strength of a Fortune 500 company
- Tuition reimbursement, training and career development
- Competitive salary, incentives, 401(k), flexible work schedules
and a healthy amount of time off
MUTUAL OF OMAHA:
Mutual of Omaha serves more than 4.8 million individual product
customers and 39,000 employer groups. Our legacy of stability
creates an environment where every associate is encouraged to
experiment, innovate and grow in their own unique career path.
From day one, you'll have the tools to be your best self at work.
Here you'll do meaningful work and your talents will have a
positive impact on peoples' lives as we help our customers protect
what they care about and achieve their financial goals.
Each associate is a unique contributor to creating a diverse,
dynamic, thriving and inclusive workplace. We want you to become
engaged --- feel a sense of belonging --- and contribute to the
company's exceptional future.
Join forces with a company that can AMPLIFY YOUR STRENGTHS AND
EMPOWER YOUR CAREER.
For inquiries about the position or application process, contact
our HR Helpline at 1-800-365-1405.
If you are a qualified individual with a disability or a disabled
veteran, you have the right to request an accommodation if you are
unable or limited in your ability to use or access our career
center as a result of your disability. To request an accommodation,
contact a Human Resources Representative at 1-800-780-0304. We are
available Monday through Friday 7 am to 4:30 pm CST we will reply
within 24 hours.
Mutual of Omaha and its affiliates are an Equal Opportunity
/Affirmative Action Employer. Qualified applicants will receive
consideration without regard to race, color, religion, sex, sexual
orientation, gender identity, national origin, disability or
protected veteran status.
To All Recruitment Agencies: We do not accept unsolicited agency
resumes and we are not responsible for any fees related to
Keywords: Mutual of Omaha, Omaha , Paid Family Medical Leave Benefit Claim Specialist/Sr. (Workplace Solutions), Healthcare , Omaha, Nebraska
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