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
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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