Appeals Specialist-Alight Leave Solutions

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.

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.

• 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.

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

Salary Pay Range

Minimum :

50,000.00 USD

Maximum :

65,000.00 USD

Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate's experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: Wellbeing and Benefits Selector Page - Alight (https://leplb0920.upoint.ap.alight.com/ah-angular-afirst-web/#/web/alight/cp/wellbeing_and_benefits_selector_page)

At Alight, we believe a company's success starts with its people. Alight embraces values that come directly from our people - purposeful, human, united and growth-minded - reflecting our inclusive culture and promise that our clients expect. We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management. Our Benefits With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities - all within a thriving global organization. Flexible Working So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and "Top 100 Company for Remote Jobs" 6 years in a row. Great Place to Work Thanks to the work of every colleague, Alight has received multiple awards of recognition including "Great Place to Work" for the past 7 years and Fortune's "Best Companies to Work For." To learn more about our company culture and awards Click Here. (http://www.alight.com/about) We invite you to join our team! Learn more at careers.alight.com (https://careers.alight.com/us/en) ., Alight requires all virtual interviews to be conducted on video. Please be aware that Alight is a camera-on culture and may require occasional travel to one of our physical office locations. Our commitment to Inclusion We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful. At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.