Sr Appeals Specialist

Symetra; United States; Hybrid; USD 66,000 - 110,000; Full time

Benefits offered by this job

Flexible full-time or hybrid telecommu

401(k) with company match up to 6%

Paid time off and holidays

Job summary

Symetra seeks a Senior Appeals Specialist to lead thorough appeals reviews of denied or terminated claims across Short Term Disability, Long Term Disability, Life, and related policies. You will ensure adherence to ERISA guidelines and collaborate with Compliance to address complaints.

The role emphasizes coordinating with claimants, providers, and employers, developing action plans, and ensuring timely, accurate appeal decisions while identifying trends to support staff development.

Qualifications

• Knowledge of disability claims processing and related policies.
• Familiarity with ERISA and regulatory timelines.

Responsibilities

• Appeals: review denied/terminated claims per plan provisions and develop action plans.
• Coordinate with claimants, providers, and employers to gather information and request reviews.
• Communicate outcomes within required timeframes and identify trends for staff development.

Job description

Symetra offers a thrilling chance to become part of our team as a Senior Appeals Specialist!

About The Role

The Appeals Specialist uses in-depth knowledge of Short Term Disability, Long Term Disability, Life, and Waiver of Premium claims processing to conduct thorough appeals reviews of terminated or denied claims and render an appeal decision. The Appeals Specialist follows department established guidelines and workflows and also adheres to ERISA and other regulatory guidelines and timeframes to prevent risk of penalties/fines. The Appeals Specialist will also work with the Compliance department to handle and respond to complaints filed on claims.

What You Will Do

• Appeals - Review appealed claims in accordance with appropriate Short Term Disability, Long Term Disability, or Life plan/policy provisions. - Develop action plans for handling appealed claims. - Implement action plans for appealed claims, which includes: contacting claimant/claimant representatives (such as attorneys) to discuss the case; contacting providers to obtain medical information; contacting employers to obtain information; and requesting medical/vocational review. - Utilize tolling and extensions when appropriate during the course of appeal reviews. - Determine appropriate type of specialty review required (vocational or medical specialty and type of review needed - peer review, IME, Occupational and/or Employability Assessment, etc) and develop specific questions to be addressed to render an accurate appeal decision. - Resolve appeals timely (within mandated timeframes) and communicate appeal outcomes to appropriate parties. - Identify trends noted through appeal reviews and communicate trends to Management team for addition developmental opportunities for staff.
• Complaints - Work with Compliance in handling and responding to complaints filed on claims, including those filed through state insurance departments, executive and presidential complaints, etc. - Create/maintain recordkeeping of new and ongoing complaint activity in required systems through to the resolution and closure of the complaint. - Maintain communications with appropriate parties related to all complaint activity. - Research and compile data and provide a drafted response to the complaint with supporting documentation for review to Compliance Officer, and Law Department when appropriate. - Send final response to complaint to appropriate party within the required timeframes. - Monitor complaints for follow-up requests and ongoing activity.

Why Work at Symetra

Here’s what some of our employees share about why they choose to work at Symetra:

"I truly believe there’s something for everyone at Symetra. No matter what your passion is, if you enjoy being part of something bigger than yourself and want to make a meaningful difference, this is the place for you. We’re more than just an insurance company—we’re a community with purpose." - Joanne S., AVP Compliance

"If given an opportunity to work for this amazing company-say yes! You will not be disappointed." - Rebecca A., Sr. Medical Risk Consultant

What We Offer You

Benefits and Perks

We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are built to make your life better both at work and at home.

• Flexible full-time or hybrid telecommuting arrangements.
• Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%.
• Paid time away including vacation and sick time, flex days and ten paid holidays.
• Give back to your community and double your impact through our company matching.
• Want more details? Check out our Symetra Benefits Overview.

Compensation

Salary Range: $66,100 - $110,100 plus eligibility for annual bonus program.

Who You Are

• High school diploma or equivalent work experience, college degree a plus.
• 5-8 years of cumulative, relevant experience.

We empower inclusion

At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute.

Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here.

Creating a world where more people have access to financial freedom

Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products--and operate our company--to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.

For more information about our careers visit: https://symetra.eightfold.ai/careers

Work Authorization

Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.

Please Review Symetra's Remote Network Minimum Requirements

As a remote-first organization with a cameras-on culture, reliable internet connectivity is important to how we connect, collaborate, and serve our customers. To support a positive experience for both employees and customers, Symetra has the following standards for employees' internet connection:

• Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."
• Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL.
• Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.

When applying to jobs at Symetra you'll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra's standard as outlined above.

Identity Verification

Symetra is committed to fair and secure hiring practices. For all roles, candidates will be required (after the initial phone screen) to be on video for all interviews. Symetra will take affirmative steps at key points in the process to verify that a candidate is not seeking employment fraudulently, e.g. through use of a false identity.

Failure To Comply With Verification Procedures May Result In

• Disqualification from the recruitment process
• Withdrawal of a job offer
• Termination of employment and other criminal and/or civil remedies, if fraud is discovered