Appeals Specialist-Alight Leave Solutions

Alight•Virtual, IL

11d•$50,000 - $65,000•Remote

About The Position

The Appeals Specialist reviews adverse determination outcomes for Short Term Disability and Long-Term Disability claims. They ensure compliance with regulatory requirements and make fair, thorough, and timely appeal determinations.

Requirements

Have experience of three or more years in STD/LTD product and claims management knowledge.
Have experience in state and federal compliance issues impacting claim administration and appeals.
Have experience with ERISA compliance claim review.
Have work experience with medical knowledge (i.e., medical terminology, medical conditions).
Demonstrate good judgment, professionalism, and the ability to handle confidential information.
Possess High School diploma or commensurate level of education required. (Bachelor’s degree preferred).
Have intermediate knowledge of Microsoft Office, including Outlook and Word.
Display good interpersonal (oral and written) communication skills and a positive attitude.
Be well organized, able to multi-task and identify priorities.

Nice To Haves

Bachelor’s degree preferred

Responsibilities

Planning, implementing, and executing the process of investigating STD and LTD claims that are in dispute; and effectively tracking and managing assigned case load of claim appeals.
Evaluating medical, financial, and non-medical information, as developed, and consulting with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
Providing clear communication to insureds, plan holders, attorneys, and others with respect to issues in dispute.
Interpreting policy provisions, state and federal regulations, department procedures and compliance directives.
Mentoring Specialists and providing guidance on the interpretation and administration of contract language.
Giving feedback to assess the training needs of the organization development offerings to enhance appeal administration skills.