Alight Solutions logo
Alight Solutions

Alight Solutions, formerly known as Aon Hewitt, is an information technology and services company that was purchased by Blackstone and relaunched as Alight Solu

Appeals Specialist

Location

Illinois

Posted

1 day ago

Salary

$50K - $65K / year

Seniority

Senior

High School3 yrs expEnglish

Job Description

Appeals Specialist

Alight Solutions

• reviews adverse determination outcomes for Short Term Disability and Long-Term Disability claims • 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 • 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

Job Requirements

  • experience of three or more years in STD/LTD product and claims management knowledge
  • experience in state and federal compliance issues impacting claim administration and appeals
  • experience with ERISA compliance claim review
  • 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)
  • 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

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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