Clinician Reviewer

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.

Serves as a clinical subject matter expert to disability case managers and provides well-reasoned and timely clinical analyses related to functional impairment. Reviews and evaluates disability claims to determine level of functioning based on knowledge of co-morbid health conditions. • Investigates and resolves inconsistencies in the level of functioning. Through a clinical advocacy approach, the clinician partners with case managers on return-towork plans via contacts with treating providers and employees when applicable. Assists in investigating and resolving inconsistencies in the level of employee functionality related to treating provider opinions, and projections of incapacity and impairment. Coordinates strategies to determine levels of employee functional capacity, utilizing direct contact with treating providers, and/or utilizing internal clinical resources (e.g. medical guidelines, independent medial reviews, internal impairment guides, claim discussion meetings, reviews). Acts as a clinical consultant and resource to the Appeals department when applicable and attends meetings as needed. Provides continuing education for case management staff via mini-clinical lectures, and assists in the development of clinical tools, guides, training, templates, processes, and protocols. Attends and/or presents clinical lectures designed to educate claims staff as requested. Facilitates referrals to ancillary internal and external services, e.g. EAP, disease management programs, advocacy, care managers, etc. as applicable. Identifies barriers in returning to work, to include identifying and prompting optimal health care to facilitate an appropriate and timely return-to-work plan and strategy. Communicates effectively with case managers, employers, employees, and health care providers. Anticipates, recognizes, and responds timely to needs of customers to ensure customer satisfaction. Supports implementation of customer initiatives to drive best outcomes. Reviews assigned customer cases, prioritizes workload, and interprets established processes and guides to resolve customer issues. Provides status updates to case managers to ensure clear communications and transparency. Resolves technical problems by referring to policies, procedures, and specifications, to ensure accuracy and operational consistency. Collects data and prepares clinical reviews, including commentary and an analysis to facilitate decision-making. Inputs relevant data into established systems accurately to allow for data analysis. Performs other related duties as required.