Appeals Specialist- Life and Voluntary Product Claims (REMOTE)
About The Position
At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential? Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and Absence Claims organization. The Life Appeals and Complaints Specialist is responsible for managing and resolving complex insurance claims disputes and regulatory complaints. This role involves investigating appeals, regulatory complaints, drafting correspondence, and ensuring compliance with regulatory standards and company policies. The specialist will act as a liaison between the claims department, legal counsel, and policyholders as necessary.
Requirements
- 3+ years of professional work experience in the insurance industry
- Experience with Group Insurance Claims (Life, Short Term Disability, Long Term Disability and/or Paid/Unpaid Leaves)
- Previous experience with Department of Insurance Complaint handling.
- Claims Management: Comprehensive understanding of insurance policies, coverage terms, medical classification and claims adjudication procedures.
- Legal Acumen: Familiarity with legal principles relevant to insurance disputes, including contract law, civil procedure, and regulatory requirements.
- Effective Communications: Excellent written and verbal communication to effectively convey information to diverse audiences including legal professionals, policy holders and internal stakeholders.
- Information Analysis and Interpretation: Ability to critically evaluate complex medical records, policy language and legal arguments to make informed decisions. Strong analytical and problem-solving skills. Maintain accurate records of all cases in system of record.
Nice To Haves
- Bachelor’s degree in Business, Healthcare Administration, or equivalent experience in a related field
- Professional work experience in group insurance claims management or appeals
- Prior experience with appeals, complaint handling or legal knowledge is beneficial
- Excellent client relationship management skills
- Strong verbal, written communication, and presentation skills
- Comfortable dealing with complexity and ambiguity and able to explore multiple solutions
- Previous experience with FINEOS Claims software platform a big plus
Responsibilities
- Claims Dispute Management:
- Handle and resolve complex insurance claims disputes efficiently.
- Investigate and analyze appeals to determine appropriate resolutions.
- Facilitate effective communication and resolution of disputes.
- Complaint Management:
- Review and respond to regulatory complaints
- Track and analyze trends for reporting
- Compliance and Standards:
- Ensure compliance with all regulatory standards and internal company policies.
- Stay updated on changes in insurance regulations and industry best practices.
- Reporting and Analysis:
- Maintain detailed records of all appeals and complaints.
- Analyze trends in claims disputes to recommend improvements in processes.
Benefits
- For eligible employees, Equitable provides a full range of benefits.
- This includes medical, dental, vision, a 401(k) plan, and paid time off.
- For detailed descriptions of these benefits, please reference the link below.
- Equitable Pay and Benefits: Equitable Total Rewards Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
