Claims Operations Director – Appeals

Alight Solutions

Claims Operations Director overseeing LOA, STD, ADA, and/or LTD Appeals service teams at Alight Solutions. Developing strategies and enhancing service delivery for workforce health and financial security.

Posted 4/14/2026full-timeRemote • Illinois • 🇺🇸 United StatesLead💰 $110,000 - $130,000 per yearWebsite

About the role

Key responsibilities & impact

Leading LOA, STD, ADA, and/or LTD Appeals service teams
Developing strategy and business plans to deliver market-centric capabilities and processes
Working with broader organization and external parties to identify and gaps and develop a plan to address
Anticipating future trends and challenges, developing and implementing strategies to address opportunities
Assessing and evaluated business/technology partners to integrate products on various platforms
Developing and recommended Claims and Service level strategies and tactics
Demonstrating expertise in accurate Appeals Claim Management
Collaborating with peers and senior leadership to deliver exceptional service
Managing Appeals departmental budget and plan effectively for responsible growth
Enhancing the Claims team through regular business updates to ensure alignment with organizational goals
Fostering a culture of trust within the team
Establishing performance metrics with clear systems of measures and accountabilities that drive results
Ensuring that an effective system of regulatory compliance and internal controls have been maintained
Complying with applicable laws and regulations, and documented procedures that incorporated preventive and defective controls
Partnering with Regulatory Compliance and Risk Committees

Requirements

What you’ll need

advanced education, equivalent work experience, training, or DMEC certification
10 years in claims/appeals and 7 years leadership in absence management
qualifications or experience in healthcare, rehabilitation, or a medical field
Lean Six Sigma Certification and or formal Operations Strategy training
experience in leadership of a team of Managers within Appeals

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Appeals Claim ManagementClaims managementBusiness strategy developmentPerformance metrics establishmentRegulatory complianceInternal controlsOperations strategyGap analysisBudget managementTeam leadership

Soft Skills

CollaborationTrust buildingCommunicationStrategic thinkingProblem-solvingOrganizational skillsAdaptabilityLeadershipTeam enhancementResults-driven

Certifications

DMEC certificationLean Six Sigma Certification