23 Sep
Disability Case Mgr II
California, Montebello 00000 Montebello USA

Vacancy expired!

Description SHIFT: Day JobSCHEDULE: Full-timeYour 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 IIResponsible for reviewing, investigating and documenting Short Term Disability (STD) and Long Term Disability (LTD) claims to determine eligibility for benefits. Typically handles 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.

Reviews claim materials against federal and state leave eligibility guidelines and adjudicates the claim.

Qualifications Qualifications

Requires a High School diploma or GED;

2 years of experience in Short Term Disability Case Management and Family Medical Leave (FML)/Absence Management;

Up to 2 years experience in claims, call center, 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.

Strong computer skills preferred.

Strong working knowledge with Microsoft suite preferred.

Strong verbal and written communication skills preferred.

Ability to multitask and prioritize 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.REQNUMBER: PS39333-US

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