Appeals Claims Specialist

Job Summary

As a remote Appeals Claims Specialist, the candidate will manage a caseload of appeals claims, providing subject matter expertise and conducting thorough reviews to determine coverage and compensability across multiple product lines.

Key responsibilities

• Analyze and process claims by investigating complex information and applying relevant policies and procedures
• Review and interpret coverage contracts to assess eligibility and resolve financial calculation discrepancies
• Provide technical guidance to claims teams and stakeholders, ensuring clarity on claim processes and determinations

Required qualifications

• 4 Year/Bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's)
• 1 - 3+ years of experience in Short-Term and/or Long-Term Disability
• Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
• Experience working with multiple products is a plus
• Presentation training or skills are desirable