Appeals Specialist-Alight Leave Solutions

Amazing Opportunity and Great Place to Work!

Do you want to be part of a collaborative Appeals team?

Our Story

At Alight, we believe a company's success starts with its people. Alight embraces values that come directly from our people - purposeful, human, united and growth-minded - reflecting our inclusive culture and promise that our clients expect. We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management.

Our Benefits

With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities - all within a thriving global organization.

Flexible Working

So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and "Top 100 Company for Remote Jobs" 6 years in a row.

Great Place to Work

Thanks to the work of every colleague, Alight has received multiple awards of recognition including "Great Place to Work" for the past 7 years and Fortune's "Best Companies to Work For." To learn more about our company culture and awards Click Here.

We invite you to join our team! Learn more at careers.alight.com.

About the Role

The Appeals Specialist reviews adverse determination outcomes for Short Term Disability and Long-Term Disability claims. They ensure compliance with regulatory requirements and make fair, thorough, and timely appeal determinations.

Responsibilities

• Planning, implementing, and executing the process of investigating STD and LTD claims that are in dispute; and effectively tracking and managing assigned case load of claim appeals.
• Evaluating medical, financial, and non-medical information, as developed, and consulting with internal and external professionals regarding issues in dispute for the purpose of resolving claims.
• Providing clear communication to insureds, plan holders, attorneys, and others with respect to issues in dispute.
• Interpreting policy provisions, state and federal regulations, department procedures and compliance directives.
• Mentoring Specialists and providing guidance on the interpretation and administration of contract language.
• Giving feedback to assess the training needs of the organization development offerings to enhance appeal administration skills.

Requirements

• Have experience of three or more years in STD/LTD product and claims management knowledge.
• Have experience in state and federal compliance issues impacting claim administration and appeals.
• Have experience with ERISA compliance claim review.
• Have work experience with medical knowledge (i.e., medical terminology, medical conditions).
• Demonstrate good judgment, professionalism, and the ability to handle confidential information.
• Possess High School diploma or commensurate level of education required. (Bachelor's degree preferred).
• Have intermediate knowledge of Microsoft Office, including Outlook and Word.
• Display good interpersonal (oral and written) communication skills and a positive attitude.
• Be well organized, able to multi-task and identify priorities.

Application and Interview

By applying for a position with Alight, you understand that, should you be made an offer, it will be contingent on your undergoing and successfully completing a background check consistent with Alight's employment policies. Background checks may include some or all the following based on the nature of the position: SSN/SIN validation, education verification, employment verification, and criminal check, search against global sanctions and government watch lists, credit check, and/or drug test. You will be notified during the hiring process which checks are required by the position.

Alight requires all virtual interviews to be conducted on video. Please be aware that Alight is a camera-on culture and may require occasional travel to one of our physical office locations.

Our commitment to Inclusion

We celebrate differences and believe in fostering an environment where everyone feels valued, respected, and supported. We know that diverse teams are stronger, more innovative, and more successful.

At Alight, we welcome and embrace all individuals, regardless of their background, and are dedicated to creating a culture that enables every employee to thrive. Join us in building a brighter, more inclusive future.

As part of this commitment, Alight will ensure that persons with disabilities are provided reasonable accommodations for the hiring process.If reasonable accommodation is needed, please contact alightcareers@alight.com.

Equal Opportunity Policy Statement

Alight is an Equal Employment Opportunity employer and does not discriminate against anyone based on sex, race, color, religion, creed, national origin, ancestry, age, physical or mental disability, medical condition, pregnancy, marital or domestic partner status, citizenship, military or veteran status, sexual orientation, gender, gender identity or expression, genetic information, or any other legally protected characteristics or conduct covered by federal, state, or local law. In addition, we take affirmative action to employ disabled persons, disabled veterans, and other covered veterans.

Alight provides reasonable accommodations to the known limitations of otherwise qualified employees and applicants for employment with disabilities and sincerely held religious beliefs, practices and observances, unless doing so would result in undue hardship. Applicants for employment may request reasonable accommodations/modifications by contacting their recruiter.

Authorization to work in the Employing Country

Applicants for employment in the country in which they are applying (Employing Country) must have work authorization that does not, now or in the future, require sponsorship of a visa for employment authorization in the Employing Country and with Alight.

Note, this job description does not restrict management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.

We offer you a competitive total rewards package, continuing education & training, and tremendous potential with a growing worldwide organization.

Salary Pay Range

Minimum :

Maximum :

Pay Transparency Statement: Alight considers a variety of factors in determining whether to extend an offer of employment and in setting the appropriate compensation level, including, but not limited to, a candidate's experience, education, certification/credentials, market data, internal equity, and geography. Alight makes these decisions on an individualized, non-discriminatory basis. Bonus and/or incentive eligibility are determined by role and level. Alight also offers a comprehensive benefits package; for specific details on our benefits package, please visit: Wellbeing and Benefits Selector Page - Alight

DISCLAIMER:

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities of this job to other entities; including but not limited to subsidiaries, partners, or purchasers of Alight business units.