Appeals Specialist

Alight Solutions

Appeals Specialist handling adverse determination outcomes for STD and LTD claims. Ensures compliance and fair appeal determinations with a focus on claims management.

Posted 7/13/2026full-timeRemote • Illinois • 🇺🇸 United StatesMid-LevelSenior💰 $50,000 - $65,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in Short Term Disability and Long-Term Disability claims management, ensuring compliance with state and federal regulations, including ERISA. Possesses strong communication skills to effectively resolve disputes and mentor team members in claims administration.

Highest-signal resume keywords

Short Term Disability Claims ManagementLong Term Disability Claims ManagementERISA ComplianceMedical Terminology KnowledgeRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims InvestigationAppeal DeterminationPolicy InterpretationCase Load ManagementMedical Information Evaluation

Soft Skills

Good JudgmentProfessionalismInterpersonal CommunicationOrganizational SkillsMulti-tasking

Tools & Technologies

Microsoft OfficeOutlookWord

Industry Keywords

Adverse DeterminationClaims AdministrationConfidential InformationTraining Needs AssessmentContract Language Interpretation

About the role

Key responsibilities & impact

reviews adverse determination outcomes for Short Term Disability and Long-Term Disability claims
ensure compliance with regulatory requirements and make fair, thorough, and timely appeal determinations
plan, implement, and execute the process of investigating STD and LTD claims that are in dispute
effectively track and manage assigned case load of claim appeals
evaluate medical, financial, and non-medical information, as developed, and consult with internal and external professionals regarding issues in dispute for the purpose of resolving claims
provide clear communication to insureds, plan holders, attorneys, and others with respect to issues in dispute
interpret policy provisions, state and federal regulations, department procedures and compliance directives
mentor Specialists and provide guidance on the interpretation and administration of contract language
give feedback to assess the training needs of the organization development offerings to enhance appeal administration skills

Requirements

What you’ll need

experience of three or more years in STD/LTD product and claims management knowledge
experience in state and federal compliance issues impacting claim administration and appeals
experience with ERISA compliance claim review
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)
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

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