Appeals Specialist

Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.

Learn more at careers.alight.com.

Job Summary

Do you want to be part of a collaborative Appeals team? The Appeals Specialist is responsible for reviewing adverse benefit determinations for Short Term Disability and Long-Term Disability (STD/LTD) claims. The Appeals Specialist will determine the appropriate claim determination on appeal, based on the information in the claim file and any additional information submitted as part of the appeal process. You will ensure that legal and ethical standards are met for the appeal and will maintain current knowledge of all ERISA/Department of Labor guidelines. For Non-ERISA plans, procedural accuracy must be followed. The Appeals Specialist will comply with all regulatory requirements by making a fair, thorough, and timely appeal determination.

Key Responsibilities

• Plan, implement, and execute the process of investigating STD and LTD claims that are in dispute; and effectively track and manage assigned case load of claim appeals.
• Evaluate medical, financial, and non-medical information, as developed, and consult with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
• Provide clear and comprehensive communication to insureds, plan holders, attorneys, and others by phone, e-mail and mail with respect to issues in dispute.
• Interpret policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentor Specialists by serving as an advisor and provide guidance on the interpretation and administration of contract language.
• Provide appropriate feedback to help assess the training needs of the organization and participate in ongoing training and development offerings to enhance appeal administration skills.
• As our Appeals Specialist, you will report to the Manager, Appeals Claim Operations

• Full time remote position.

Knowledge, Skills, Abilities, and Experience

Knowledge, Education, Certification, Skills & Technical Proficiencies

• High School diploma or commensurate level of education required. (Bachelor's degree preferred).

• Intermediate knowledge of Microsoft Office, including Outlook and Word.

Work Experience

• 3 plus years of STD/LTD product and claim management knowledge .
• Expert knowledge of state and federal compliance issues impacting claim administration and appeals.
• ERISA compliance claim review experience.
• Working medical knowledge (i.e., medical terminology, medical conditions).
• Demonstration of good judgment, professionalism, and the ability to handle confidential information.
• Must possess strong interpersonal (oral and written) communication skills and a positive attitude.
• Well organized, able to multi-task and identify priorities

Flexible Working

So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and "Top 100 Company for Remote Jobs" 5 years in a row.

Benefits

We offer programs and plans for a healthy mind, body, wallet and life because it's important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as a number of voluntary benefit options.

By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight's employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position.

Our commitment to Diversity and Inclusion

Alight is committed to diversity, equity, and inclusion. We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.

At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.

Diversity Policy Statement

Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state or local law. In addition, we take affirmative action to employ and advance in the employment of qualified minorities, women, disabled persons, disabled veterans and other covered veterans.

Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting his/her recruiter.

Authorization to work in the Employing Country

Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the Employing Country and with Alight.

Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

Salary Pay Range

Minimum :
46,200 USD
Maximum :
73,300 USD

Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate's experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: https://bit.ly/Alight_Benefits

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, pregnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law. Alight Solutions is committed to a diverse workforce and is an affirmative action employer.