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Disability Case Manager I/II - Atlanta, GA - PS26155Location: United StatesNewRequisition #: PS29024Your 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 benefits companies and a Fortune Top 50 Company.Disability Case Manager I/II Manager will determine level based upon the selected applicant’s skill-set relative to the qualifications listed for this position.Disability Case Manager IResponsible for reviewing, investigating and documenting Short Term Disability (STD) and Long Term Disability (LTD) claims to determine eligibility for benefits. Typically handles non-statutory, non-occupational claims that are within duration guidelines.Primary duties may include, but are not limited to:
Reviews claim materials against disability policy coverage to determine liability and adjudicates the claim.
Gathers clinical and eligibility information to verify approved period of disability.
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.
Disability Case Manager IIResponsible for reviewing, investigating and documenting Short Term Disability (STD) and Long Term Disability (LTD) claims to determine eligibility for benefits. Typically handles non-statutory, non-occupational claims that are within duration guidelines.Primary duties may include, but are not limited to:
Reviews claim materials against disability policy coverage to determine liability and adjudicates the claim.
Gathers clinical and eligibility information to verify approved period of disability.-
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.
Qualifications:Disability Case Manager I
Requires a High School diploma or GED;
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.
Working knowledge with Microsoft suite preferred
Disability Case Manager II
Requires a High School diploma or GED;
2 years of experience in Disability 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.
Working knowledge with Microsoft suite preferred
Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2018 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran.
