Specialist, Appeals Claims (Short-Term Disability)
About The Position
As an Appeals Specialist you will be responsible for being a product subject matter expert to provide full, fair appeal reviews for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will analyze and manage a caseload of appeals claims. You will review, investigate, and make claim determinations regarding coverage, compensability, and appropriateness of claims. You will provide technical information and detailed guidance to Claims management & teams regarding products, claims processes, regulations, and applicable systems for their assigned claims area. If this sounds like a role for you, please read on!
Requirements
- 4 Year/Bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's)
- 1 - 3+ Years of Short-Term and/or Long-Term Disability. (Required)
- Ability to communicate effectively (verbal/written)
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
Nice To Haves
- Experience working with multiple products.
- Presentation training or skills
- Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
- SystemOne experience
Responsibilities
- Analyze & process claims by investigating & obtaining a wide range of complex information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
- Analyze and interpret complex coverage contracts to determine if eligibility is met.
- Identify, interpret, and resolve gaps in financial calculations and offsets when applicable, share technical knowledge and approach on financial calculations with team members that involve complex contract provisions.
- Research questions and escalations from Claims team; liaises with various stakeholders from across the business (Underwriting, Actuarial, Compliance, Account Management, etc.) to obtain needed information to clarify and address issues.
- Provide customers with in-depth explanations of policy details, claim process, and claim determination; ensure parties understand the information and outcome.
- Utilize internal reporting to identify trends and review/audit performance against team metrics; propose and develop practices & processes to improve performance and the customer experience.
- Effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims workflow. Provide detailed guidance & coaching to junior team members.
Benefits
- Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes
- Leadership development and virtual training opportunities
- PTO/parental leave
- Competitive 401K and employee benefits
- Free financial counseling, health coaching and employee assistance program
- Tuition assistance program
- Work arrangements that work for you
- Effective productivity/technology tools and training
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Insurance Carriers and Related Activities
Number of Employees
5,001-10,000 employees
