Senior Appeals Specialist

Job Summary

To support the review process of claims, the full-time Senior Appeals Specialist will conduct thorough appeals reviews of terminated or denied Short Term Disability, Long Term Disability, and Life claims, while adhering to regulatory guidelines and collaborating with the Compliance department on complaints.

Key responsibilities

• Review and manage appealed claims in accordance with policy provisions, developing and implementing action plans
• Collaborate with Compliance to handle and respond to complaints filed on claims, ensuring accurate recordkeeping and timely communication
• Identify trends in appeal reviews and communicate findings to management for staff development opportunities

Required qualifications

• High school diploma or equivalent work experience; college degree preferred
• 5-8 years of cumulative, relevant experience in claims processing or appeals
• In-depth knowledge of Short Term Disability, Long Term Disability, and Life claims
• Experience working with regulatory guidelines such as ERISA
• Ability to manage multiple tasks and meet mandated timeframes effectively