Appeals Specialist

Our story At 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 ROLE Are 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. RESPONSIBILITIES Manage 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 directives Serve 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. REQUIREMENTS High 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 effectively Flexible Working So that you can be your best at work and home, we For full info follow application link. 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, pregnancy, 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