Appeals Specialist

Job Summary

Working remotely in a full-time capacity, the Appeals Specialist will leverage expertise in claims adjudication and risk management to guide clients through the appeals process, ensuring compliance and effective communication with stakeholders.

Key responsibilities

• Reviews and evaluates benefit determination materials for various appeals, overcoming objections and clarifying issues as needed
• Renders appeal decisions using medical, vocational, and legal resources, serving as a technical expert in client appeal activities
• Prepares professional written communications and maintains accurate records of appeal causes and dispositions

Required qualifications

• At least 8 years of direct Group Disability industry experience with a strong understanding of claims adjudication and contract interpretation
• Demonstrated high-level risk management and analytical skills, along with the ability to interpret and communicate disability contract language
• Experience conducting presentations and collaborating with legal teams, including participation in depositions or trials
• Ability to manage multiple priorities effectively and de-escalate situations regularly
• Access to high-speed internet and located in the United States or Puerto Rico