Disability Appeals Specialist (Remote-Friendly)

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

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.