Note: The job is a remote job and is open to candidates in USA. Alight Solutions is committed to empowering its employees and fostering a diverse work environment. The Appeals Support Specialist will provide essential administrative support to the Appeal and Claims departments, ensuring efficient processing of appeals and claims while maintaining strong communication with clients and vendors.
Responsibilities
- Monitor all new appeal receipts from a work queue for timely assignments based on approved workflows. Research Client processes to assign or return as needed and will set future tasking based on the specific requirements based on product. General correspondence will be sent to include acknowledgement notices and other letter template/email needs as required
- Provide clear and comprehensive communication to insureds, plan holders, attorneys, and others by phone, e-mail and mail with respect to issues in dispute
- Work and data will accurately be added and monitored in the Appeal Log and/or similar tracking tools for reporting purposes
- Incoming correspondence will be monitored through Mailbox and portal platforms to add or upload to the associated claim. Tasking will be set as needed to alert its assigned Appeal Specialist or Case Manager etc
- Will partner with several contracted vendors and Claims teams to assist with various referrals and timely return and tracking of said reports. These can include Independent Medical Exams, Peer Reports, Fit for Duty exams, Translations services, Special Investigations, and various document and file requests. Will help facilitate any associated communication/questions between parties through the completion of each request
- Will take lead role in the preparation, build, and completion of various file copies or Grievance file needs based on the specific Client need and processes
- Meet or exceed Department Goals and Objectives including strong teamwork initiatives
- Comply with state and federal regulations, department procedures and compliance directives
- Provide appropriate feedback to help assess the training needs of the organization and participate in ongoing training and development offerings to enhance administration skills
Skills
- Graduate in listed discipline BA, B.Com, BCA ( No Gaps / Failure throughout Graduation)
- Overall, 5 and above years of work experience with LOA claims or support function within an insurance/ financial organization
- Ability to work evening/night shifts
- Data analysis and reporting proficiency
- Excellent written and verbal communication
- Intermediate knowledge of Microsoft Office, including Outlook, SmartSheets, Teams, Excel and Word
- Basic knowledge of state and federal compliance issues impacting claim administration and appeals
- Demonstration of good judgment, professionalism, and the ability to handle confidential information
- Well organized, able to multi-task and identify priorities
- Prior experience with disability products (STD/LTD), Leave programs, ERISA regulations, and medical terminology would be beneficial, to include knowledge of TPA operations
Benefits
- Programs and plans for a healthy mind, body, wallet and life
- A variety of health coverage options
- Wellbeing and support programs
- Retirement
- Vacation and sick leave
- Maternity, paternity & adoption leave
- Continuing education and training
- A number of voluntary benefit options
Company Overview