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Disability Case Manager Lead - Atlanta, GA - PS14266 in Atlanta, GA at Anthem, Inc.

Date Posted: 1/8/2019

Job Snapshot

Job Description

Your 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 Lead

Location: 3350 Peachtree  Road, Atlanta, GA 30326 (this is an in-office only position)

Responsible for investigating and documenting Short Term Disability (STD) claims for group policyholders. 

Typically handles non-statutory, non-occupational claims that are within duration guidelines. 

Primary duties may include, but are not limited to: 
  • Administers disability income payments on behalf of group policyholders. 
  • Gathers clinical and eligibility information to verify approved period of disability. 
  • Reviews claim materials against STD disability policy coverage. 
  • Determines liability and adjudicates the claim. 
  • Works with Disability Management nurses, and Physician Reviewers to review complex/questionable claims. 
  • Obtains necessary agreements to determine FICA, and Federal and State income tax requirements. 
  • Review ongoing disability claims to determine continued liability for the company. 
  • Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering. 
  • Handles escalated cases from the DCM I. 
  • Provides testimony involved in depositions in contested claims. 
  • Administers payments on a monthly and weekly basis. 
  • Performs calculations for adjustments for Social Security and Workers Compensation awards. 
  • Mails appropriate State program forms to employees. 


Qualifications:
  • Requires a BA/BS; 
  • 6 years’ experience in customer service or insurance claims, preferably in the managed care or insurance sectors
  • Or, any combination of education and experience, which would provide an equivalent background.
  • Knowledge of WGS, Compass and Facets
  • Proficient in Microsoft Excel, Word, Outlook 
  • Proficient in partial calculations
  • Skills – multi-tasking is a must, time management, strong customer focus, ability to mentor new hires.

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


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