Appeals Specialist, Disability Claims

Equitable; United States; On-site; USD 50,000 - 65,000; Full time

Job summary

Equitable is seeking an Appeals Specialist for its Disability Claims organization. This role involves managing complex insurance claims disputes, preparing legal documentation, and ensuring compliance with regulations. Ideal candidates will have 3+ years in the insurance industry and experience with group insurance claims.

Benefits

Medical, dental, and vision insurance

401(k) plan

Paid time off

Qualifications

• 3+ years of professional work experience in the insurance industry.
• Experience with Group Insurance Claims (Life, Short Term Disability, Long Term Disability).

Responsibilities

• Handle and resolve complex insurance claims disputes efficiently.
• Prepare and review legal documentation related to claims disputes and appeals.
• Ensure compliance with all regulatory standards and internal company policies.

Skills

Claims Management

Legal Acumen

Effective Communications

Information Analysis and Interpretation

Education

Bachelor’s degree in Business, Healthcare Administration, or equivalent experience

Job description

Join to apply for the Appeals Specialist, Disability Claims role at Equitable

Join to apply for the Appeals Specialist, Disability Claims role at Equitable

At Equitable, our power is in our people. We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential?

Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and Absence Claims organization. The Appeals, Complaints, and Litigation Specialist is responsible for managing and resolving complex insurance claims disputes. This role involves investigating appeals, preparing applicable legal documentation, and ensuring compliance with regulatory standards and company policies. The specialist will act as a liaison between the claims department, legal counsel, and policyholders as necessary.

Key Job Responsibilities

• Claims Dispute Management:
• Handle and resolve complex insurance claims disputes efficiently.
• Investigate and analyze appeals to determine appropriate resolutions.
• Facilitate effective communication and resolution of disputes.
• Legal Documentation:
• Prepare and review legal documentation related to claims disputes and appeals.
• Collaborate with legal counsel to ensure all documentation meets legal standards.
• Compliance and Standards:
• Ensure compliance with all regulatory standards and internal company policies.
• Stay updated on changes in insurance regulations and industry best practices.
• Reporting and Analysis:
• Maintain detailed records of all appeals and complaints.
• Analyze trends in claims disputes to recommend improvements in processes.
  

The base salary range for this position is $50,000 - $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short-term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off. For detailed descriptions of these benefits, please reference the link below.

Equitable Pay and Benefits: Equitable Total Rewards Program

Required Qualifications

• 3+ years of professional work experience in the insurance industry
• Experience with Group Insurance Claims (Life, Short Term Disability, Long Term Disability and/or Paid/Unpaid Leaves)
  
  

Preferred Qualifications

• Bachelor’s degree in Business, Healthcare Administration, or equivalent experience in a related field
• Professional work experience in group insurance claims management or appeals
• Prior experience with appeals, litigation support or legal knowledge is beneficial
• Excellent client relationship management skills
• Strong verbal, written communication, and presentation skills
• Comfortable dealing with complexity and ambiguity and able to explore multiple solutions
• Previous experience with FINEOS Claims software platform a big plus
  
  

Skills

Claims Management: Comprehensive understanding of insurance policies, coverage terms, medical classification and claims adjudication procedures.

Legal Acumen: Familiarity with legal principles relevant to insurance disputes, including contract law, civil procedure, and regulatory requirements.

Effective Communications: Excellent written and verbal communication to effectively convey information to diverse audiences including legal professionals, policy holders and internal stakeholders.

Information Analysis and Interpretation: Ability to critically evaluate complex medical records, policy language and legal arguments to make informed decisions. Strong analytical and problem-solving skills. Maintain accurate records of all cases in system of record.

About Equitable

At Equitable, we’re a team committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.

We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.

We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.

We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose.

Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.

NOTE: Equitable participates in the E-Verify program.

If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at [phone] or email us at [e-mail].

Primary Location

UNITED STATES-NC-Charlotte

Other Locations

UNITED STATES-Remote, UNITED STATES-NY-Syracuse

Organization

Equitable

Schedule

Full-time

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Legal

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