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PLADS Appeals Consultant

Salary Range: $75,000 - $95,000 Job Posting End Date: June 8th 2026 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? <ul style="margin-bottom:0.0in;margin-top:0.0px"> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Acting with Integrity</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Communicating Effectively</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Pursuing Self-Development</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Serving Customers</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Supporting Change</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Supporting Organizational Goals</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Working with Diverse Populations</li> </ul> What does it take to be successful in this role? • Proficient in ERISA regulations including 2018 regulatory changes/requirements. • Demonstrated ability to analyze medical, vocational, and technical information to support claim/appeal decisions. • Strong documentation, organization, and communication skills. • Proficiency with claim management systems and Microsoft Office applications. Education & Experience Required <ul style="margin-bottom:0.0in;margin-top:0.0px"> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Bachelor's Degree In healthcare, business, or a related field </li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">5 or more years of job-related experience working with disability, life, or related group benefits, including direct involvement with appeal handling and/or complex claim review.</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Working knowledge of STD, LTD, Life, Premium Waiver, AD&D, TPA and voluntary product coverage for Fully Insured and ASO customers.</li> <li style="margin:0.0in 0.0in 0.0in 0.0px;font-size:10.0pt;font-family:'Times New Roman', serif">Experience working within regulated environments (ERISA, DOI/DOL compliance).</li> </ul> Or an equivalent combination of education and experience Travel Less than or equal to 10% Principal Duties & Responsibilities • Reviews and evaluates appeal requests across STD, LTD, Life, PW, AD&D, TPA, statutory and voluntary benefit products for fully insured and ASO customers. • Conducts a complete review of claim files, medical documentation, policy information and related materials to support accurate and fair appeal decisions within required timeframes. • Ensures decisions comply with ERISA, state regulations and internal policies and procedures. • Performs research to clarify plan provisions, identify relevant information, and support case resolution. • Consults with medical directors, clinical resources, legal team members, other internal stakeholders, and contracted external resources to gather input for more complex cases. • Documents all findings, actions taken, and appeal determinations clearly and fully in the claim system to ensure proper audit and reporting practices. • Communicates appeal decisions in a clear and professional manner to claimants, employers, and other stakeholders. • Prioritizes and manages assigned workload to meet productivity, quality, and regulatory requirements. • Identifies cases requiring escalation based on complexity, risk, or unique circumstances. • Supports a positive customer experience by responding to questions and working collaboratively with internal partners. • Performs other related duties as required. Total Rewards The salary range for this job is $75,000 to $95,000. 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.

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