Remote Appeals Specialist, Group Disability Claims

Mutual of Omaha Insurance Co.; United States; Remote; USD 54,000 - 90,000; Full time

Benefits offered by this job

401(k) plan with company match

Remote work flexibility

Job summary

Mutual of Omaha Insurance Co. is seeking an Appeals Specialist to adjudicate complex disability and life claim appeals from a remote location within the United States.

The role emphasizes risk management, contract interpretation, and collaboration with the Law Division, claimants, and brokers. Ideal candidates have 6+ years of direct group disability experience, strong analytical skills, and the ability to mentor staff.

Qualifications

• At least 6 years of direct Group Disability industry experience and thorough understanding of claims adjudication, benefit determination, investigation, file development, legal requirements, and contract interpretation.

Responsibilities

• Reviews and evaluates all pre- and post-adverse benefit determination materials for Group STD, LTD, Life, AD&D, Waiver of Premium, CI and Accident appeals; overcome objections through effective appeal arguments, escalate appropriately, and requests additional information as needed to clarify issues.
• Renders appeal decisions using medical, vocational and legal risk management resources; serves as a technical expert to guide client appeal activities and leverages contract language to support sound determinations.
• Prepares clear, professional written communications to claimants, representatives, policyholders, brokers and attorneys; documents actions thoroughly and maintains accurate records of appeal cause, disposition and trending.
• Ensures compliance with ERISA and applicable federal and state laws; researches and evaluates emerging case law and regulatory changes, presents cases in forums, and remains current on company, industry and legislative updates.
• Drives continuous improvement by identifying technological and process enhancements; mentors and trains staff and clients on appeals and risk management, contributes to internal policy development, and partners with operations to ensure alignment on key processes.

Skills

Claims adjudication

Risk management

Contract interpretation

Legal knowledge

Analytical skills

Job description

Mutual of Omaha Insurance Co. is seeking an Appeals Specialist to adjudicate complex disability and life claim appeals from a remote location within the United States.

The role emphasizes risk management, contract interpretation, and collaboration with the Law Division, claimants, and brokers. Ideal candidates have 6+ years of direct group disability experience, strong analytical skills, and the ability to mentor staff.