Founded in 1909, Mutual of Omaha is a solid, family-oriented company that's reliable, trustworthy, knowledgeable and caring.

We are a full-service, multi-line provider of insurance and financial services products for individuals, businesses and groups throughout the United States.

We are committed to providing outstanding service to our policyholders.

Our commitment to customer service is the cornerstone of our vision and values.

Under minimal supervision, applies knowledge and expertise to complex appeals/legal cases, training mentoring of staff, reports, and quality reviews on Appeals Specialists.

Performs and evaluates appeal trending analysis to internal business areas.

Also, contributes to and produces communications related to procedures.

Sr. Appeals Specialist will carry a reduce appeals case load with the following job functions: Reviews all information submitted, both pre and post adverse benefit determination, for Group Short/ Long Term Disability, Life /Life/AD&D/Waiver, Individual Disability, and Health product lines.

Documents all actions in a clear concise mannerMaintains accurate records of cause / origin and disposition of appeals.

Requests submission of additional information to clarify issues as necessary.

Renders decisions on claim appeals utilizing risk management resources (i.

e., medical, vocational, and legal resources).

Communicates with Claimants, their Representatives, Group Policyholders, & Brokers in a professional manner.

Responsible for complying to all federal and state regulations including ERISAResponsible for complying to internal appeals guidelinesParticipate in monthly team meetings and inter-departmental meetingsMINIMUM QUALIFICATIONS/REQUIREMENTSThis job requires a background that demonstrates the following minimum knowledge, skills, talents and traits: Thorough understanding of claim adjudication, benefit determination, investigation, file development, legal requirements, and contract interpretation 3 years minimum of disability claims paying and/or disability appeals experience preferred Experience interpreting state and federal laws and technical legal language including complex benefit plans to facilitate implementation of enhancements to systems, policy and procedures to ensure quality and compliance standards are maintained Excellent oral and written communication, analytical, planning organizational, leadership and training skills, problem solving, and decision making skills Leadership skills and ability to coordinate and direct activities of team members Ability and desire to train and mentor less experienced staff Ability to travel up to 30-50% of the work period and valid driver's license Knowledge of various claim systems and ability to adapt to new systems Extensive knowledge of Medical Terminology Extensive knowledge of CPT and ICD9 coding Effective organizational skills, time management, and ability to manage multiple priorities Ability to work independently and efficiently in pressure situations, demonstrating a high level of flexibility in a rapidly changing environment Physical Requirements Key-boarding/Writing/ Pinching (working primarily with fingers) - >66%Handling (working primarily with hands such as grasping, turning, sorting) - 34-66%Paced Work (physical productivity/quota demands) - 34-66%Static reaching (working with elbows away from body) - 1-33%Reaching above shoulder(s) - 1-33%Sitting - 34-66%Standing/Walking -1-33%Bending/Stooping - 1-33%Talking - 34-66%Near Vision -Visual Acuity at 20 inches or less - >66%Far Vision- Visual Acuity at 20 feet or more - 1-33%Hearing - >66%Lifting/Carrying (10-19lbs) 1-33% Pre-placement physical exam required? No Mutual of Omaha is an Equal Opportunity Employer

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