Salary Range: $65,000 - $85,000 Job Posting End Date: This job will be posted on an ongoing basis. We’ve Got You Under Our Wing We are the duck. We develop and empower our people, cultivate relationships, give back to our community, and celebrate every success along the way. We do it all…The Aflac Way. Aflac, a Fortune 500 company, is an industry leader in voluntary insurance products that pay cash directly to policyholders and one of America's best-known brands. Aflac has been recognized as Fortune’s 50 Best Workplaces for Diversity and as one of World’s Most Ethical Companies by Ethisphere.com. Our business is about being there for people in need. So, ask yourself, are you the duck? If so, there’s a home, and a flourishing career for you at Aflac. Worker Designation – This role is a remote role. This means you will be expected to work from your home, within the continental US. If the role is remote, there may be occasions that you are requested to come to the office based on business need. Any requests to come to the office would be communicated with you in advance. What does it take to be successful at Aflac? - Acting with Integrity - Communicating Effectively - Pursuing Self-Development - Serving Customers - Supporting Change - Supporting Organizational Goals - Working with Diverse Populations What does it take to be successful in this role? • Strong understanding of disability claims management concepts. • Solid understanding of medical terminology/pathology/anatomy. • Ability to verbally articulate clearly, concisely and explain complex situations. • Superior writing skills. • Confident with independent decision making. • Ability to consistently meet deadlines. • Proven ability to work with confidential information. • Moderate skills with Microsoft Office and other software applications. • High level of customer service skills/phone skills. • Strong ability to multi-task and prioritize. • Must have a high level of attention to detail. • Results-driven. • High attention to deliver on departmental/company procedures/practices. • Ability to work Independently. • Strong negotiation skills. Education & Experience Required - High School Diploma or equivalent - 5 or more years of LTD industry claims experience. - Demonstrated proficiency in product specific areas of STD, LTD or Account Management, and federal and state regulations governing these products and services Or an equivalent combination of education and experience Education & Experience Preferred - Bachelor's Degree Business, or healthcare related field - 4 or more years of experience in disability management industry managing claims Principal Duties & Responsibilities • Makes timely, accurate, and customer-focused Long-Term Disability new and ongoing claim decisions on moderately complex to highly complex claims using advanced independent discretion guided by company procedures and regulatory standards; handles the most complex claims from a clinical and financial perspective; reaches out to obtain relevant clinical, vocational, employer, financial, and other information; compares the information to the terms, limitations, and conditions of the contract/administrative services agreement and applicable procedural documents and renders the claim decision as quickly as possible • Documents the claims system in an accurate and comprehensive manner; prepares, updates, and utilizes a claim management plan to attain the most appropriate outcome; remains in full compliance with regulatory requirements; demonstrates an above average level of proficiency in product and claims administration techniques; remains fully compliant with operational standards; meets or exceeds claim team operational metrics • Maintains a superior level of genuine caring and empathetic customer service throughout all interactions; takes appropriate actions to earn the claimant's and employer's trust and confidence; anticipates customer’s needs and takes action as appropriate • Works with internal partners to support flexibility, collaboration, creating a positive work environment, consistently maintaining professionalism and integrity, actively taking steps to foster high morale, and demonstrating a dedication to excellence • Mentors and coaches new team members and participates in projects supporting the team's business initiatives • Performs other related duties as required Total Rewards The salary range for this job is $65,000 to $85,000. This range is specific to the job and salary offers consider a wide range of factors that are considered in making compensation decisions, including, but not limited to: education, experience, licensure, certifications, geographic location, and peer compensation. The range has been created in good faith based on information known to Aflac at the time of the posting. At Aflac, it is not typical for an individual to be hired at or near the top of the range for the role to allow for future and continued salary growth, and compensation decisions are dependent on the circumstances of each case. This salary range does not include any potential incentive pay or benefits, however, such information will be provided separately when appropriate. In addition to the base salary, we offer an array of benefits to meet your needs including medical, dental, and vision coverage, prescription drug coverage, health care flexible spending, dependent care flexible spending, Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no costs to employee), 401(k) plans, annual bonuses, and an opportunity to purchase company stock. On an annual basis, you’ll also be offered 11 paid holidays, up to 20 days PTO to be used for any reason, and, if eligible, state-mandated sick leave (Washington employees accrue 1-hour sick leave for every 40 hours worked) and other leaves of absence, if eligible, when needed to support your physical, financial, and emotional well-being. Aflac complies with all applicable leave laws, including, but not limited to, sick and safe leave, and adoption and parental leave, in all states and localities.

The Claims Examiner is responsible for the accurate and timely processing of medical, dental, vision and prescription drug claims. The incumbent is expected to provide courteous and prompt responses to customer inquiries. The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position. ESSENTIAL JOB FUNCTIONS: - Essential job functions include the following. Other functions may be assigned as business conditions change. - Verifies the accuracy and receipt of all required documentation for each claim submitted. - Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim. - Analyzes information necessary for processing. This includes, but is not limited to, general participant and provider information, managed care affiliation, diagnosis codes, dates, place, type of service, procedure codes, and charges. - Assures that the system processes the claim correctly and determines payment according to the plan as written. - Word-processes correspondence to plan participants and providers in reference to pre-determinations and in response to basic benefit questions. - Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries. - Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims. - Assigns critically ill patients to large case management. Assists the case manager with direct negotiation and the efficient use of benefits. - Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent. - Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review. - Researches, calculates and requests refunds when necessary. - Contributes to the daily workflow with regular and punctual attendance. - Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department. - Process eligible claims on groups before the end of their stoploss contract renewal period. - Assists the Legal Department with subrogation claims as necessary. - Attends various group meetings as required. - Assists with audits as needed. - Assists with plan benefit set-up and changes as needed. Minimum Education: High school graduation or GED required. Minimum Experience: Basic computer and customer service experience required. Other Qualifications: - Excellent oral and written communication skills required. - PC skills, including Windows and Word. - Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication. - Must be able to adapt to software changes as they occur. - Typing ability of 45 wpm net - Excellent listening skills. - Basic mathematical skills. - High level of interpersonal skills to work effectively with others. - Ability to organize and recall large amounts of detailed information. - Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations. - Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy. - Thorough knowledge of claims processing procedures and requirements. - Ability to project a professional image and positive attitude in any work environment. - Ability to comply with privacy and confidentiality standards. - Ability to be flexible, work under pressure and meet deadlines. - Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions. - Ability to operate typical office equipment. - Working knowledge of general office procedures. About Allegiance by Cigna Healthcare Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Description Summary Under general supervision assures accurate and timely insurance claim processing to include resolving claim edits and paper claims for submittal. Resolves denied/unpaid insurance claims in a timely manner. Entity Medical University Hospital Authority (MUHA) Worker Type Employee Worker Sub-Type​ Regular Cost Center CC005226 SYS - HB Support Services Pay Rate Type Hourly Pay Grade Health-20 Scheduled Weekly Hours 40 Work Shift Job Description - Account maintenance: Updating registration, authorization issues, identifying charge correction, , processing adjustments as needed and denial follow up according to payer rules and departmental policies. - Use electronic billing system appropriately to follow up on outstanding denied claims and all no response claims.Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can't resolve - Follow up on denied or no response claims by calling third party payers or using payer websites. Gathering information from patients or other areas to resolve outstanding denied or no response claims. Researching accounts to take appropriate action necessary to resolve. - Keep management aware of issues and trends to enhance operations and escalates slow-pay issues to managerial level when necessary. - Uses payer websites to stay current on payer rules and changes to include reading newsletters and communicating payer/claim issues and trends. - Maintains 95% quality standards on account follow and activity. - Maintains productivity standard as set forth by management team. - Other duties as assigned. Additional Job Description Education: High School Degree or Equivalent Work Experience: 0-6months If you like working with energetic enthusiastic individuals, you will enjoy your career with us! The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need. Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please click here: http://www.uscis.gov/e-verify/employees

• Analyzes and processes complex or technically difficult auto liability PIP/No-fault claims by investigating and gathering information to determine coverage, the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Calculates and assigns timely and appropriate reserves to claims. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution.