Appeals Specialist

Alight Solutions

. Plan, implement, and execute investigations of disputed STD and LTD claims .

Posted 11/10/2026full-timeRemote • Illinois • United StatesMid-LevelSenior💰 $50,000 - $65,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced knowledge of disability products and claim management, with expertise in state and federal compliance issues impacting claim administration. Proficient in evaluating medical and financial information while effectively communicating with various stakeholders.

Highest-signal resume keywords

Advanced Knowledge Of Disability ProductsExpert Knowledge Of State And Federal Compliance3+ Years Of STD/LTD Product And Claim ManagementERISA Compliance Claim Review ExperienceExcellent Interpersonal And Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claim ManagementDisability Products KnowledgeMedical TerminologyRegulatory ComplianceClaim Appeals EvaluationPolicy InterpretationCaseload ManagementInvestigation ExecutionFeedback AssessmentTraining Development

Soft Skills

Good JudgmentProfessionalismOrganizational SkillsMultitasking AbilityConfidential Information Handling

Tools & Technologies

Microsoft OfficeOutlookWord

Industry Keywords

STD ClaimsLTD ClaimsERISA ComplianceClaim AdministrationCompliance Directives

About the role

Key responsibilities & impact

Plan, implement, and execute investigations of disputed STD and LTD claims
Track and manage an assigned caseload of claim appeals
Evaluate medical, financial, and non-medical information
Consult internal and external professionals to resolve disputed claims
Communicate with insureds, plan holders, attorneys, and others by phone, email, and mail
Interpret policy provisions, state and federal regulations, department procedures, and compliance directives
Mentor Specialists and advise on interpretation and administration of contract language
Provide feedback to assess organizational training needs
Participate in ongoing training and development to enhance appeal administration skills
Review and determine outcomes for Short Term Disability and Long-Term Disability claim appeals while ensuring regulatory compliance

Requirements

What you’ll need

High School diploma or commensurate level of education required
Bachelor’s degree ideal (not required)
Advanced knowledge of disability products and claim management
Intermediate knowledge of Microsoft Office, including Outlook and Word
3+ years of STD/LTD product and claim management knowledge
Expert knowledge of state and federal compliance issues impacting claim administration and appeals
ERISA compliance claim review experience
Working medical knowledge, including medical terminology and medical conditions
Good judgment, professionalism, and ability to handle confidential information
Excellent interpersonal, oral, and written communication skills
Well organized and able to multitask and identify priorities
Work authorization in the United States without current or future visa sponsorship requirement
Successful completion of applicable background checks

Benefits

Comp & perks

Health, dental, and vision coverages starting Day One
Wellbeing programs
Retirement plans with contribution matching
Generous time off
Parental leave
Continuing education
Career growth opportunities
Flexible working arrangements where possible
Competitive total rewards package
Background check and hiring-process accommodations as applicable