Appeals Specialist- Leave Solutions

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

Amazing Opportunity and Great Place to Work!

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." To learn more about our company culture and awards .

We invite you to join our team! Learn more at

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. This includes 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.

• 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 provide 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.

• 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.

Al…