[Hiring] STD Claims Appeals Specialist @Lincoln Financial

Role Description

We are excited to bring on an Appeals Specialist to join our Appeal Review Department in a fully remote environment. Appeal Specialists conduct reviews, investigation, and analysis of an assigned caseload of Short-Term Disability appeals. The role is responsible for interpreting and applying correct contract terms/provisions, ERISA requirements, statutory guidelines, and case management and appeal procedures to each claim.

What you'll be doing

• Analyze & process claims by investigating & obtaining a wide range of complex information.
• Apply claim policies & procedures and engage intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims.
• Analyze and interpret complex coverage contracts to determine if eligibility is met.
• Identify and resolve gaps in financial calculations and offsets when applicable; share technical knowledge and approach on financial calculations with team members.
• Interpret calculations correctly involving complex contract provisions and work with applicable resources as needed to resolve issues.
• Research questions and escalations from Claims team; liaise with various stakeholders from across the business (Underwriting, Actuarial, Compliance, Account Management, etc.) to obtain needed information to clarify and address issues.
• Provide customers with in-depth explanations of policy details, claim process, and claim determination; ensure parties understand the information and outcome.
• Utilize internal reporting to identify trends and review/audit performance against team metrics; propose and develop practices & processes to improve performance and the customer experience.
• Effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims workflow. Provide detailed guidance & coaching to junior team members.

Qualifications

• 4 Year/Bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's)
• 3+ years of claims and/or appeals experience with LTD/STD claims
• Ability to communicate effectively (verbal/written)
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)

Requirements

• Experience working with multiple products (Nice-to-have)
• Presentation training or skills (Nice-to-have)
• Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
• SystemOne experience (Nice-to-have)

Benefits

• Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes
• Leadership development and virtual training opportunities
• PTO/parental leave
• Competitive 401K and employee benefits
• Free financial counseling, health coaching and employee assistance program
• Tuition assistance program
• Work arrangements that work for you
• Effective productivity/technology tools and training