Appeals Specialist-Alight Leave Solutions

Amazing Opportunity and Great Place to Work!

Do you want to be part of a collaborative Appeals team?

At Alight, we believe a company’s success starts with its people. Alight embraces values that come directly from our people – purposeful, human, united and growth-minded – reflecting our inclusive culture and promise that our clients expect. We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.

With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities – all within a thriving global organization.

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” 6 years in a row.

Thanks to the work of every colleague, Alight has received multiple awards of recognition including “Great Place to Work” for the past 7 years and Fortune’s “Best Companies to Work For.”

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

• Planning, implementing, and executing the process of investigating STD and LTD claims that are in dispute; and effectively tracking and managing assigned case load of claim appeals.
• Evaluating medical, financial, and non-medical information, as developed, and consulting with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
• Providing clear communication to insureds, plan holders, attorneys, and others with respect to issues in dispute.
• Interpreting policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentoring Specialists and providing guidance on the interpretation and administration of contract language.
• Giving feedback to assess the training needs of the organization development offerings to enhance appeal administration skills.

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

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.

Alight requires all virtual interviews to be conducted on video. Please be aware that Alight is a camera-on culture and may require occasional travel to one of our physical office locations.

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