Appeals Specialist

🔥 2 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $50k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Alight Solutions

WebsiteLinkedInAll Job Openings

10,000+ employees

🤝 B2B

🏥 Healthcare

☁️ SaaS

💰 $22.5M Post-IPO Secondary - Alight Solutions on 2023-08

B2B • Healthcare • SaaS

Alight Solutions is a leading benefits administration provider that delivers health, wealth, leave, and related HR point solutions for large organizations and their employees. The company helps manage benefits administration and human capital-related processes for enterprises, serving many of the world’s largest organizations and over 30 million people. Alight also emphasizes product and technology roles, corporate sustainability, total rewards, and a focus on transforming lives and organizations by maximizing health, financial and work wellbeing.

📋 Description

• 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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