Anthem, Inc. Disability Case Manager Sr. in Walnut Creek, California
SHIFT: Day Job
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 Sr.
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.
Requires a BA/BS;
6 years’ experience in customer service or insurance claims, preferably in the managed care or insurance sector o r, 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.
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.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.