Lead Operations Specialist - Appeal Support

Lead - Operations (Appeal Support Specialist)

Our story

At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.”

Our Values:

Champion People – be empathetic and help create a place where everyone belongs.

Grow with purpose – Be inspired by our higher calling of improving lives.

Be Alight – act with integrity, be real and empower others.

It’s why we’re so driven to connect passion with purpose. Our team’s expertise in human insights and cloud technology gives companies and employees around the world the ability to power confident decisions, for life.

 With a comprehensive total rewards package, continuing education and training, and tremendous potential with a growing global organization, Alight is the perfect place to put your passion to work.

 Join our team if you Champion People, want to Grow with Purpose through acting with integrity and if you embody the meaning of Be Alight.

 Learn more at careers.alight.com. 

(THE ROLE)

The Appeals Support Specialist will provide administrative support and guidance to both the Appeal and Claims departments regarding disability and leaves administration through Third Party Administration services. This position will research each new appeal receipt to verify acceptance and assignment to the Appeal Specialists. Each receipt will be logged and assigned based on department guidelines and Client needs. Acknowledgement and general correspondence will be sent as needed, and future tasking established and set within multiple Claims payment systems. Additional duties will include the submission and monitoring of vendor-related services and the timely uploading of documents into the associated claim. File copy builds will also be a routine function within this role as well as the management of multiple mailbox systems. This role is clerical in nature requiring strong attention to detail and the ability to multi-task several Client and department processes for accuracy. May also assist with team projects and audits as necessary.

Key Responsibilities

• Monitor all new appeal receipts from a work queue for timely assignments based on approved workflows. Research Client processes to assign or return as needed and will set future tasking based on the specific requirements based on product. General correspondence will be sent to include acknowledgement notices and other letter template/email needs as required.
• Provide clear and comprehensive communication to insureds, plan holders, attorneys, and others by phone, e-mail and mail with respect to issues in dispute.
• Work and data will accurately be added and monitored in the Appeal Log and/or similar tracking tools for reporting purposes.
• Incoming correspondence will be monitored through Mailbox and portal platforms to add or upload to the associated claim. Tasking will be set as needed to alert its assigned Appeal Specialist or Case Manager etc.
• Will partner with several contracted vendors and Claims teams to assist with various referrals and timely return and tracking of said reports. These can include Independent Medical Exams, Peer Reports, Fit for Duty exams, Translations services, Special Investigations, and various document and file requests.  Will help facilitate any associated communication/questions between parties through the completion of each request.
• Will take lead role in the preparation, build, and completion of various file copies or Grievance file needs based on the specific Client need and processes.
• Meet or exceed Department Goals and Objectives including strong teamwork initiatives.
• Comply with state and federal regulations, department procedures and compliance directives.
• Provide appropriate feedback to help assess the training needs of the organization and participate in ongoing training and development offerings to enhance administration skills.

Eligibility & Knowledge

• Graduate in listed discipline BA, B.Com, BCA ( No Gaps / Failure throughout Graduation)
• Overall, 6 and above years of work experience with LOA claims or support function within an insurance/ financial organization
• Ability to work evening/night shifts
• Data analysis and reporting proficiency
• Excellent written and verbal communication
• Intermediate knowledge of Microsoft Office, including Outlook, SmartSheets, Teams, Excel and Word.
• Prior experience with disability products (STD/LTD), Leave programs, ERISA regulations, and medical terminology would be beneficial, to include knowledge of TPA operations.
• Basic knowledge of state and federal compliance issues impacting claim administration and appeals.
• Demonstration of good judgment, professionalism, and the ability to handle confidential information.
• Well organized, able to multi-task and identify priorities.

Benefits

We offer programs and plans for a healthy mind, body, wallet and life because it’s important our benefits care for the whole person. Options include a variety of health coverage options, wellbeing and support programs, retirement, vacation and sick leave, maternity, paternity & adoption leave, continuing education and training as well as a number of voluntary benefit options. 

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.

Our commitment to Diversity and Inclusion

Alight is committed to diversity, equity, and 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.

Diversity 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 and advance in the employment of qualified minorities, women, disabled persons, disabled veterans and other covered veterans.

Alight provides reasonable accommodation 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 accommodation/modification by contacting his/her 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 know 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.

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.

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Experience Level

Senior Level