[Hiring] Appeals Specialist @Alight

Role Description

The Appeals Specialist reviews and determines outcomes for Short Term Disability and Long-Term Disability claim appeals. They ensure compliance with legal and ethical standards, including ERISA and Department of Labor guidelines, while adhering to procedural accuracy for non-ERISA plans. The role requires fair, thorough, and timely appeal decisions in line with regulatory requirements.

Responsibilities

• Planning, implementing, and executing the process of investigating STD and LTD claims that are in dispute.
• Effectively tracking and managing assigned case load of claim appeals.
• Evaluating medical, financial, and non-medical information, as developed.
• Consulting with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
• Communicating effectively with insureds, plan holders, attorneys, and others via phone, email, and mail regarding disputed issues.
• Interpreting policy provisions, state and federal regulations, department procedures, and compliance directives.
• Mentoring Specialists by serving as an advisor and providing guidance on the interpretation and administration of contract language.
• Providing appropriate feedback to help assess the training needs of the organization.
• Participating in ongoing training and development offerings to enhance appeal administration skills.

Qualifications

• Possess High School diploma or commensurate level of education required. Bachelor’s would be ideal.
• Have advanced knowledge of disability products and claim management.
• Demonstrate intermediate knowledge of Microsoft Office, including Outlook and Word.
• 3+ years of STD/LTD product and claim management knowledge.
• Have expert knowledge of state and federal compliance issues impacting claim administration and appeals.
• Have ERISA compliance claim review experience.
• Display working medical knowledge (i.e., medical terminology, medical conditions).
• Demonstrate good judgment, professionalism, and the ability to handle confidential information.
• Possess excellent interpersonal (oral and written) communication skills and a positive attitude.
• Be well organized and able to multi-task and identify priorities.

Requirements

• Background check consistent with Alight’s employment policies.
• Virtual interviews to be conducted on video.
• Occasional travel to one of our physical office locations may be required.

Benefits

• Comprehensive total rewards package.
• Health, dental, and vision coverages starting Day One.
• Wellbeing programs.
• Retirement plans with contribution matching.
• Generous time off and parental leave.
• Continuing education and career growth opportunities.
• Flexible working arrangements.