Appeals Specialist
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Job Description
Appeals Specialist reviewing STD and LTD claim appeals for Alight’s benefits and absence-management business. Investigating disputes, interpreting regulations, and determining compliant outcomes.
Responsibilities:
- Plan, implement, and execute investigations of disputed STD and LTD claims
- Track and manage an assigned caseload of claim appeals
- Evaluate medical, financial, and non-medical information
- Consult internal and external professionals to resolve disputed claims
- Communicate with insureds, plan holders, attorneys, and others by phone, email, and mail
- Interpret policy provisions, state and federal regulations, department procedures, and compliance directives
- Mentor Specialists and advise on interpretation and administration of contract language
- Provide feedback to assess organizational training needs
- Participate in ongoing training and development to enhance appeal administration skills
- Review and determine outcomes for Short Term Disability and Long-Term Disability claim appeals while ensuring regulatory compliance
Requirements:
- High School diploma or commensurate level of education required
- Bachelor’s degree ideal (not required)
- Advanced knowledge of disability products and claim management
- Intermediate knowledge of Microsoft Office, including Outlook and Word
- 3+ years of STD/LTD product and claim management knowledge
- Expert knowledge of state and federal compliance issues impacting claim administration and appeals
- ERISA compliance claim review experience
- Working medical knowledge, including medical terminology and medical conditions
- Good judgment, professionalism, and ability to handle confidential information
- Excellent interpersonal, oral, and written communication skills
- Well organized and able to multitask and identify priorities
- Work authorization in the United States without current or future visa sponsorship requirement
- Successful completion of applicable background checks
Benefits:
- Health, dental, and vision coverages starting Day One
- Wellbeing programs
- Retirement plans with contribution matching
- Generous time off
- Parental leave
- Continuing education
- Career growth opportunities
- Flexible working arrangements where possible
- Competitive total rewards package
- Background check and hiring-process accommodations as applicable
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