Disability Claims Appeal & Complaints Analyst
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Job Description
Disability Claims Appeal & Complaints Analyst handling appeals and regulatory complaints for insurance claims. Reviewing adverse decisions and ensuring compliance with regulations and policies.
Responsibilities:
- Analyst will handle appeals submitted on Disability (STD, LTD, Leave) products.
- Review adverse claim life decisions within STD, LTD, State Leave product line.
- Review claim files in depth and detail to determine if previous claim decision (adverse claim decision) was appropriate or if prior decision should be reversed.
- Provide high level feedback on claim handling.
- Handle appeals in line with job aids in place.
- Responsible for reviewing regulatory & presidential complaints and providing responses to appropriate agency.
Requirements:
- Prior claim handling experience in fully and self-insured STD, LTD and State Leave lines of business.
- Prior Appeal handling experience in fully/self insured STD, LTD, State Leave lines of business including decision letter writing.
- Prior Complaint handling experience (regulatory, Sr. Officer, Presidential).
- Contract review and interpretation.
- Letter writing skills.
- FINEOS experience is preferred
- Microsoft office products Excel experience/knowledge PowerPoint experience
Benefits:
- medical
- dental
- vision
- 401(k) plan
- paid time off
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