Appeals Specialist-Alight Leave Solutions

Alight; Belleville (IL); Hybride; USD 60 000 - 80 000; Plein temps

Résumé du poste

Alight is seeking an Appeals Specialist to review and determine outcomes for Short Term Disability and Long Term Disability claim appeals, ensuring compliance with ERISA and related guidelines. This role focuses on fair, thorough, and timely decisions within regulatory standards.

You will manage a workload of appeals, collaborate with internal and external professionals, and communicate decisions to insureds, plan holders, and attorneys, contributing to a compliant and efficient appeals process.

Qualifications

• Experience reviewing Short Term Disability and Long Term Disability claims.
• Familiarity with ERISA, Department of Labor guidelines, and non-ERISA plans.
• Ability to interpret policy provisions and regulations.
• Mentor colleagues on contract language interpretation.

Responsabilités

• Plan, implement, and execute investigation of disputed STD and LTD claims.
• Track and manage assigned claim appeals workload.
• Evaluate medical, financial, and other information as developed.
• Consult with internal and external professionals regarding issues in dispute for resolution.
• Communicate with insureds, plan holders, attorneys, and others via phone, email, and mail regarding disputed issues.
• Interpret policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentor specialists by serving as an advisor and provide guidance on interpretation and administration of contract language.
• Provide feedback to help assess training needs of .

Connaissances

Dispute investigation

Regulatory compliance

Communication skills

Claims knowledge

Description du poste

Do you want to be part of a collaborative Appeals team?

Amazing Opportunity and Great Place to Work!

Our Story

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.

We invite you to join our team! Learn more at careers.alight.com.

About the Role

The Appeals Specialist reviews and determines outcomes for Short Term Disability and Long-Term Disability claim appeals. They ensure compliance with legal and ethical standards. This includes ERISA and Department of Labor guidelines, while adhering to procedural accuracy for non-ERISA plans. The role requires fair, thorough, and timely appeal decisions in line with regulatory requirements.

Responsibilities

• 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.
• Consulting with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
• Communicating effectively with insureds, plan holders, attorneys, and others via phone, email, and mail regarding disputed issues.
• Interpreting policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentoring Specialists by serving as an advisor and provide guidance on the interpretation and administration of contract language.
• Providing appropriate feedback to help assess the training needs of