Short Term Disability Appeals Specialist
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Job Description
Short-term disability appeals specialist reviewing coverage, eligibility, and claim determinations for Lincoln Financial’s insurance customers. Managing complex appeals caseloads and guiding claims teams on policies, regulations, and systems.
Responsibilities:
- Serve as a product subject matter expert and provide full, fair appeal reviews for multiple product lines
- Perform and deliver appeals claims assignments and projects
- Analyze and manage a caseload of appeals claims
- Review, investigate, and make claim determinations regarding coverage, compensability, and claim appropriateness
- Provide technical information and detailed guidance to Claims management and teams regarding products, claims processes, regulations, and applicable systems
- Analyze and process claims by investigating and obtaining complex information
- Apply claim policies and procedures and engage internal/external resources for fair, ethical, and timely claim management
- Analyze and interpret complex coverage contracts to determine eligibility
- Identify, interpret, and resolve gaps in financial calculations and offsets
- Share technical knowledge regarding financial calculations involving complex contract provisions
- Research questions and escalations from Claims teams and liaise with Underwriting, Actuarial, Compliance, Account Management, and other stakeholders
- Explain policy details, claim processes, and claim determinations to customers
- Use internal reporting to identify trends and audit performance against team metrics
- Propose and develop practices and processes to improve performance and customer experience
- Apply policies and procedures regarding medical terminology, duration, functionality documentation, and claims workflow
- Provide detailed guidance and coaching to junior team members
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 experience (Required)
- Ability to communicate effectively (verbal/written)
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
- Experience working with multiple products (nice-to-have)
- Presentation training or skills (nice-to-have)
- Excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail (nice-to-have)
- SystemOne experience (nice-to-have)
Benefits:
- Clearly defined career tracks and job levels
- 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
- Flexible work arrangements
- Effective productivity/technology tools and training
- Annual Incentive Program eligibility
- Potential long-term incentives and sales incentives
- Lincoln’s standard benefits package
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