Appeals Specialist

Our storyAt Alight, we believe a company's success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to "Be Alight."Our Values:Champion People - be empathetic and help create a place where everyone belongs.Grow with purpose - Be inspired by our higher calling of improving lives.Be Alight - act with integrity, be real and empower others.It's why we're so driven to connect passion with purpose. Alight helps clients gain a benefits advantage while building a healthy and financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, absence management and navigation.With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.Learn more at careers.alight.com.THE ROLEAre you interested in joining a collaborative Appeals team? As an Appeals Specialist, you'll review adverse determinations for Short-Term Disability (STD) and Long-Term Disability (LTD) claims, ensuring compliance with legal and ethical standards. You'll make appeal decisions based on claim file information and additional submissions, adhering to ERISA/Department of Labor guidelines and ensuring accuracy for Non-ERISA plans. This role requires staying updated on regulatory requirements and making fair, thorough, and timely determinations with a focus on quality and accuracy.RESPONSIBILITIESManage the investigation of disputed Short-Term Disability (STD) and Long-Term Disability (LTD) claims, ensuring each case is effectively tracked and managed through the appeals process.Assess medical, financial, and non-medical information with the support of internal and external experts to resolve disputed claims.Provide clear, comprehensive communication with insured individuals, plan holders, attorneys, and other parties via phone, email, and mail on claim-related issues.Interpret policy provisions, and ensure compliance with state and federal regulations, department procedures, and directivesServe as a mentor to Specialists by offering guidance on interpreting and administering contract language.Offer constructive feedback to help identify training needs, and participate in ongoing professional development to enhance appeal administration skills.REQUIREMENTSHigh school diploma or equivalent level of education required; Bachelor's degree preferred.Proficiency with Microsoft Office, especially Outlook and Word.At least three years of experience with STD/LTD claims and product management.In-depth understanding of state and federal compliance issues related to claims and appeals, including ERISA.Familiarity with medical terminology and conditions.Strong judgment, professionalism, and ability to handle confidential information.Excellent interpersonal skills, both written and verbal, with a positive, proactive attitude.Highly organized, with the ability to multi-task and prioritize effectivelyFlexible Working 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" 5 years in a row.BenefitsWe offer programs and plans for a healthy mind, body, wallet and life because it's important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as a number of voluntary benefit options. 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.Our commitment to Diversity and InclusionAlight is committed to diversity, equity, and inclusion. We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.As part of this commitment, Alight will ensure that persons with disabilities are provided reasonable accommodations for the hiring process.If reasonable accommodation is needed, please contact alightcareers@alight.com. Diversity Policy StatementAlight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, p regnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state or local law. In addition, we take affirmative action to employ and advance in the employment of qualified minorities, women, disabled persons, disabled veterans and other covered veterans.Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request a reasonable accommodation/modification by contacting his/her recruiter.Authorization to work in the Employing CountryApplicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the Employing Country and with Alight.Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.Salary Pay RangeMinimum :46,200 USDMaximum :73,300 USDPay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate's experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: https://bit.ly/AlightBenefitsDISCLAIMER:Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.affirmative action employer.Alight Solutions provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, p regnancy, childbirth or related medical condition, veteran, marital, parental, citizenship, or domestic partner status, or any other status protected by applicable national, federal, state or local law. Alight Solutions is committed to a diverse workforce and is an