Appeals Specialist

🔥 5 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

• Reviewing adverse determination outcomes for Short Term Disability and Long-Term Disability claims. • Ensuring compliance with regulatory requirements. • Making fair, thorough, and timely appeal determinations. • Planning, implementing, and executing the process of investigating STD and LTD claims that are in dispute. • 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. • 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.

🎯 Requirements

• 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.

🏖️ 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