Appeals Specialist

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🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $50k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Alight Solutions

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 2016

🏢 Enterprise

👥 HR Tech

☁️ SaaS

Enterprise • HR Tech • SaaS

Alight Solutions is a leading cloud-based human capital technology and services provider serving some of the world's largest organizations and over 35 million people and dependents. The company focuses on transforming lives and organizations by enhancing health, financial, and work wellbeing. Alight offers a wide range of services, including customer care, technology roles, consulting, application services, and business support, with opportunities for virtual or work-from-home positions. The company emphasizes corporate social responsibility and providing a positive impact on clients, colleagues, and communities.

📋 Description

• reviews adverse determination outcomes for Short Term Disability and Long-Term Disability claims • ensure compliance with regulatory requirements and make fair, thorough, and timely appeal determinations • plan, implement, and execute the process of investigating STD and LTD claims that are in dispute • effectively track and manage assigned case load of claim appeals • evaluate medical, financial, and non-medical information, as developed, and consult with internal and external professionals regarding issues in dispute for the purpose of resolving claims • provide clear communication to insureds, plan holders, attorneys, and others with respect to issues in dispute • interpret policy provisions, state and federal regulations, department procedures and compliance directives • mentor Specialists and provide guidance on the interpretation and administration of contract language • give feedback to assess the training needs of the organization development offerings to enhance appeal administration skills

🎯 Requirements

• experience of three or more years in STD/LTD product and claims management knowledge • experience in state and federal compliance issues impacting claim administration and appeals • experience with ERISA compliance claim review • 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) • 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

🏖️ 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