The Disability Care Coordinator/Senior Approver (Union Role) – DCC is responsible for the management of Disability claims for group policyholders to include investigation, documentation, and authorization of payment. The DCC also pays claims and completes minor adjustments. There is constant interaction with claimants, medical professionals, and other vendors. DCC will handle statutory, occupational, and non-occupational claims as well as claims that fall outside duration guidelines.
DUTIES AND RESPONSIBILITIES:
• Responsible for adjudicating all STD claims in a timely manner
• Manage claims in accordance with company standards, which includes the Statement of Work and Client Contract Plan Language
• Providing excellent customer service
• Gather clinical and confirm eligibility information to verify approved period of disability
• Maintain awareness of the ERISA, Fair Claims Practices Model Act, privacy regulations, and state-mandated laws, and abides by them as dictated by each individual claim
• Actively enlist the services of support services (Physician Advisor, Vocational Rehabilitation, etc.) to assist with claim management
• Ability to interact with treating sources to negotiate appropriate treatment plan and return to works
• Responsible for timely and accurate payment of Disability claims
• Ability to determine and withhold FICA, Federal, State and Local taxes when making claim payments
• Knowledge of the necessary agreements to determine and withhold Support Orders, Garnishment, Bankruptcy, Federal and State Levies
• Determine and calculate appropriate offsets
• Correspond via letter and telephone with employee, physicians, employers, hospitals, rehabilitation and other vendors to obtain claim information
• Is responsible for mailing appropriate state program forms as well as required company disability forms to the employee
• General claims support duties to include telephone coverage
• Other duties as assigned.
• Preferred: BA and/or equivalent work experience
• Basic computing and keyboarding skills required with proficiency in Word and Excel
• Excellent oral and written communication skills including active listening;
• Ability to make timely and effective decisions
• Ability to work independently as well as working effectively in a team environment
• Provides superior, professional and courteous service to our customers
• Provides timely and accurate resolution of inquiries and issues regarding claim payment regarding benefits, policies, and contracts
• Handles complex calls and situations by taking ownership of issues to ensure timely resolution or follow-up
• Conducts research and resolves issues
• Participates in special projects assigned
• Demonstrates full competence in own work area
• Makes significant contribution to work team
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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 Elevance Health. 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 Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact firstname.lastname@example.org for assistance.