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Alight Solutions logo
Alight Solutions

Alight Inc. (NYSE: ALIT) is a leading cloud-based human capital technology and services provider

Claims Operations Director – Appeals

OperationsOperationsFull TimeRemoteLeadTeam 10,001+Since 2016H1B SponsorCompany SiteLinkedIn

Location

Illinois

Posted

66 days ago

Salary

$110K - $130K / year

Seniority

Lead

Bachelor Degree10 yrs expEnglish

Job Description

Claims Operations Director – Appeals

Alight Solutions

• Leading LOA, STD, ADA, and/or LTD Appeals service teams • Developing strategy and business plans to deliver market-centric capabilities and processes • Working with broader organization and external parties to identify and gaps and develop a plan to address • Anticipating future trends and challenges, developing and implementing strategies to address opportunities • Assessing and evaluated business/technology partners to integrate products on various platforms • Developing and recommended Claims and Service level strategies and tactics • Demonstrating expertise in accurate Appeals Claim Management • Collaborating with peers and senior leadership to deliver exceptional service • Managing Appeals departmental budget and plan effectively for responsible growth • Enhancing the Claims team through regular business updates to ensure alignment with organizational goals • Fostering a culture of trust within the team • Establishing performance metrics with clear systems of measures and accountabilities that drive results • Ensuring that an effective system of regulatory compliance and internal controls have been maintained • Complying with applicable laws and regulations, and documented procedures that incorporated preventive and defective controls • Partnering with Regulatory Compliance and Risk Committees

Job Requirements

  • advanced education, equivalent work experience, training, or DMEC certification
  • 10 years in claims/appeals and 7 years leadership in absence management
  • qualifications or experience in healthcare, rehabilitation, or a medical field
  • Lean Six Sigma Certification and or formal Operations Strategy training
  • experience in leadership of a team of Managers within Appeals

Benefits

  • health, dental and vision coverages starting Day One
  • wellbeing programs
  • retirement plans with contribution matching
  • generous time off
  • parental leave
  • continuing education
  • career growth opportunities

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