Appeals Specialist-Alight Leave Solutions

About the Role

The Appeals Specialist reviews adverse determination outcomes for Short Term Disability (STD) and Long‑Term Disability (LTD) claims. They ensure compliance with regulatory requirements and make fair, thorough, and timely appeal determinations.

• 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 communication to insureds, plan holders, attorneys, and others with respect to issues in dispute.
• Interpret policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentor specialists and provide guidance on the interpretation and administration of contract language.
• Give feedback to assess the training needs of the organization development offerings to enhance appeal administration skills.

• Three or more years of experience in STD/LTD product and claims management.
• Experience in state and federal compliance issues impacting claim administration and appeals.
• Experience with ERISA compliance claim review.
• Work experience with medical knowledge (medical terminology, medical conditions).
• Demonstrate good judgment, professionalism, and the ability to handle confidential information.
• High school diploma or commensurate level of education required (Bachelor’s degree preferred).
• Intermediate knowledge of Microsoft Office, including Outlook and Word.
• Good interpersonal (oral and written) communication skills and a positive attitude.
• Well‑organized, able to multi‑task and identify priorities.

Salary Pay Range:
Minimum $50,000.00

USD – Maximum $65,000.00

USD.

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.

Alight also takes affirmative action to employ disabled persons, disabled veterans, and other covered veterans.

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