Job Posting End Date: February 26

When you join the team at Unum, you become part of an organization committed to helping you thrive.

Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life’s moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:

• Award-winning culture

• Inclusion and diversity as a priority

• Performance Based Incentive Plans

• Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability

• Generous PTO (including paid time to volunteer!)

• Up to 9.5% 401(k) employer contribution

• Mental health support

• Career advancement opportunities

• Student loan repayment options

• Tuition reimbursement

• Flexible work environments

• All the benefits listed above are subject to the terms of their individual Plans.

And that’s just the beginning…

With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you’re directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!

This position has overall responsibility for managing a team of clinicians who are responsible for educating Stop Loss Underwriters and providing accurate financial projections and evaluations of medical treatment costs of individuals identified in new and renewal business underwriting process by reviewing medical information pertinent to individual claimants. The incumbent is charged with ensuring thorough, fair and objective claim evaluations, providing the highest level of quality and service to the underwriting team.

This position is responsible for the overall quality and effectiveness of the clinical reviews which entail projecting claim costs as well as the accuracy for high-cost claims and will share in the overall financial performance for the stop loss financials.

Principle Duties and Responsibilities

• Manage a clinical team that provides reviews for new and renewal business, including expectations for service standards for timeliness, quality and accuracy of the risk assessments.
• Oversight of accurate financial assessment of the risk which includes projecting the financial liability of the claims while considering both the underlying medical condition and drug costs.
• Provides strong leadership and direction to the clinical team who specialize in accurate financial assessment for the claimants of concern.
• Foster a high-performance organization in support of Unum’s enterprise goals to protect more workers, delight customers, deliver efficiency and engage employees
  • Participate in any external vendor relationships
  • Develop and support continuous improvements in organizational efficiency and effectiveness to deliver on commitments with quality and accuracy to all key stakeholders
  • Support employee engagement and bring solutions to support and maintain a high-performing and positive work environment
• Champion Unum’s inclusion and diversity efforts and support/enable employee participation in Employee Networks and I&D events
• Responsible for personnel selection/retention of diverse talent
• Accountable for managing team performance to expectations for timeliness, accuracy, and quality assessments for the claim projections through coaching clinical professionals and monitoring the clinical reviews.
• Ensure that initial claim assessment and financial projections are correct and appropriate and that timely decisions are made back to the underwriting team.
• Foster strong partnerships with key, internal areas such as Underwriting, Policies & Practices, Quality Assurance, Training, Audit, Finance and Claims team.
• Implement and effectively lead teams through change with minimal disruption
• Maintain a comprehensive quality assurance program
• During the busy season, the incumbent will perform clinical reviews in addition to the management responsibilities.
• Maintain CE hours to meet State RN Licensure and CCM (or Industry) certification renewal requirements.
• Mentor new team members as needed
• Performs other duties as required

Job Specifications

Requires deep and working knowledge of the following:

• Standard treatment plans by diagnosis including medical and surgical modalities for adult and pediatric claimants and rehabilitation programs
• Physician interventions including frequency of involvement and specialist interventions
• Current chemotherapy regimens for malignancies both primary and secondary
• Common diagnoses that result in solid organ or hemopoietic transplants and a thorough understanding of the transplant process including the transplant evaluation, listing process, use of a vendor when warranted and the average wait time for all types of transplants
• The care required for the premature neonate and their transition into the home setting
• High-cost drug therapies for specific diagnoses including orphan drugs
• Home care requirements including skilled nursing, rehabilitation, and durable medical equipment

Requires the following experience and skills

• Bachelor’s/Associates degree preferred or relevant experience
• 3+ years nurse clinical experience and 2+ years case management experience
• 2+ years’ experience in health care or health insurance industry; stop loss or reinsurance preferred
• Registered Nurse
• Previous management of a service-oriented team is strongly preferred
• Able to make balanced and objective decisions with the highest degree of integrity; strong decision making and problem-solving skills
• Demonstrated presentation and facilitation skills; ability to effectively and professionally interact/partner with internal and external audiences at various levels and with varying needs
• Ability to interpret plan language in specific plan documents to assist with coverage determinations both in an underwriting and claim capacity
• Ability to use varying resources (e.g., systems, applications, and tools) to retrieve data and research diagnoses, treatments, and average costs.
• Strong computer proficiency (MS Word, Outlook, Excel, and PowerPoint)
• Strong understanding of and ability to take appropriate actions based on key business indicators/trends (quality and effectiveness)
• Demonstrated collaboration, partnership and conflict management skills
• Proven ability to coach team members regarding individual capabilities, and proposed development actions needed to build additional competence to lead people to achieve their full potential
• Excellent communication skills both written and verbal
• Proven leadership skills and strong management competency
• Ethical, able to maintain confidentiality and respectful of others
• Occasional travel required

Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.

The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.

$87,200.00-$152,600.00

Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.

Company:

Unum