Remote Appeals Specialist – Disability Claims

Alight; Illinois; On-site; USD 50,000 - 65,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Disability product knowledge

ERISA compliance

Interpersonal communication

Organizational skills

Confidential information handling

Education

High School diploma

Bachelor's degree preferred

Tools

Microsoft Office

Job description

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.