Senior Bilingual Disability Appeals Expert

Medavie; United States; Remote; USD 58,000 - 65,000; Full time

Benefits offered by this job

Flexible work arrangements

Health, vision and dental plan (employ

Defined Contribution Pension Plan

Annual Incentive Bonus

Paid vacation and Vacation Purchase

Wellness benefits

Career Growth

Job summary

Medavie is seeking an Appeals Specialist to conduct independent reviews of appealed Life, Disability, and related insurance claims. You will evaluate medical, contractual, administrative, and occupational information to determine appropriate outcomes and provide defensible decision rationales.

As a senior SME, you will coach Claims Examiners and collaborate with medical consultants, legal counsel, and plan sponsors to promote consistency and accuracy in claims management.

Qualifications

• Minimum 5 years of progressive experience in Life and Disability claims adjudication, case management, appeals, or related insurance role.
• Strong ability to interpret contracts, policy provisions, and claims management practices.
• Ability to communicate complex decisions clearly both verbally and in writing.

Responsibilities

• Conduct independent reviews of appealed Life and Disability claims, and related insurance claims.
• Interpret contracts, policy provisions, and internal guidelines to ensure consistent decisions.
• Identify opportunities for quality improvements and support implementation across claims operations.
• Provide guidance to Claims Examiners, Case Managers, Team Leaders, and stakeholders.
• Communicate appeal outcomes and rationale to internal and external partners.

Skills

5+ years claims experience

Education

Post-secondary education in Business Admin / Health Sciences / Nursing / Rehabilitation / Insurance / Law

Job description

Medavie is seeking an Appeals Specialist to conduct independent reviews of appealed Life, Disability, and related insurance claims. You will evaluate medical, contractual, administrative, and occupational information to determine appropriate outcomes and provide defensible decision rationales.

As a senior SME, you will coach Claims Examiners and collaborate with medical consultants, legal counsel, and plan sponsors to promote consistency and accuracy in claims management.