Appeals Specialist-Alight Leave Solutions

Alight; Illinois; Sur place; USD 50 000 - 65 000; Plein temps

Résumé du poste

Alight is seeking an Appeals Specialist in the United States to review and determine outcomes for Short Term Disability and Long-Term Disability claim appeals. The role ensures compliance with ERISA and Department of Labor guidelines, while adhering to non-ERISA rules.

Strong judgment and confidentiality are essential. Responsibilities include investigating disputed claims, managing caseloads, and mentoring colleagues on contract interpretation and regulatory compliance.

Qualifications

• 3+ years of STD/LTD product and claim management knowledge.
• Knowledge of state and federal compliance issues impacting claim administration.
• Excellent written and oral communication, and ability to handle confidential information.

Responsabilités

• Planning, investigating, and managing the process of STD/LTD claim appeals.
• Effectively tracking and managing the assigned case load of claim appeals.
• Evaluating medical, financial, and non-medical information as developed.
• Consulting with internal and external professionals to resolve dispute issues.
• Communicating with insureds, plan holders, attorneys, and others via phone, email, and mail.
• Interpreting policy provisions, state and federal regulations, and procedures.
• Mentoring Specialists and providing guidance on contract language interpretation.
• Providing feedback to help assess training needs of the organization.
• Participating in ongoing training to enhance appeal administration skills.

Connaissances

Disability product knowledge

ERISA compliance

Interpersonal communication

Organizational skills

Confidential information handling

Formation

High School diploma

Bachelor's degree preferred

Outils

Microsoft Office

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.

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 the organization.
• Participating in ongoing training and development offerings to enhance appeal administration skills.

Requirements

• Possess High School diploma or commensurate level of education required. Bachelor’s would be ideal.
• Have advanced knowledge of disability products and claim management.
• Demonstrate intermediate knowledge of Microsoft Office, including Outlook and Word.
• 3+ years of STD/LTD product and claim management knowledge.
• Have expert knowledge of state and federal compliance issues impacting claim administration and appeals.
• Have ERISA compliance claim review experience.
• Display working medical knowledge (i.e., medical terminology, medical conditions).
• Demonstrate good judgment, professionalism, and the ability to handle confidential information.
• Possess excellent interpersonal (oral and written) communication skills and a positive attitude.
• Be well organized and able to multi-task and identify priorities.

Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

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

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. As part of this commitment, Alight will ensure that persons with disabilities are provided reasonable accommodations for the hiring process. If reasonable accommodation is needed, please contact [e-mail].

Equal Opportunity Policy Statement

Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ disabled persons, disabled veterans, and other covered veterans. Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request reasonable accommodations/modifications by contacting their recruiter.

Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, pregnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law. Alight Solutions is committed to a diverse workforce and is an affirmative action employer.

Authorization to work in the Employing Country

Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not, now or in the future, require sponsorship of a visa for employment authorization in the Employing Country and with Alight.

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

Disclaimer

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.