Short Term Disability Appeals Specialist

This is a fully remote position, open to applicants in Nebraska, +1 more state.

📋 Description

• Act as a product subject matter expert and conduct thorough, impartial appeal reviews across various product lines.

• Execute and deliver assignments and projects related to appeals claims.

• Manage and analyze a caseload of appeals claims efficiently.

• Review, investigate, and make determinations on claims regarding coverage, compensability, and appropriateness.

• Offer technical insights and detailed support to Claims management and teams about products, claims processes, regulations, and relevant systems.

• Analyze and process claims by investigating and gathering intricate information.

• Implement claim policies and procedures while engaging internal and external resources for equitable, ethical, and timely claim management.

• Assess and interpret complex coverage contracts to ascertain eligibility.

• Identify, interpret, and rectify discrepancies in financial calculations and offsets.

• Share expertise regarding financial calculations involving intricate contract provisions.

• Research inquiries and escalations from Claims teams and collaborate with Underwriting, Actuarial, Compliance, Account Management, and other stakeholders.

• Clarify policy details, claim processes, and claim decisions to customers.

• Utilize internal reporting to detect trends and evaluate performance against team metrics.

• Suggest and develop practices and processes aimed at enhancing performance and customer experience.

• Implement policies and procedures concerning medical terminology, duration, functionality documentation, and claims workflow.

• Provide comprehensive guidance and coaching to junior team members.

⛳️ Requirements

• Bachelor’s degree or equivalent work experience (4 years of experience may substitute for a Bachelor's degree).

• 1 - 3+ years of experience in Short-Term and/or Long-Term Disability (Required).

• Strong verbal and written communication skills.

• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).

• Experience with multiple products (preferred).

• Presentation skills or training (preferred).

• Exceptional organizational abilities with the capacity to prioritize tasks and multitask while maintaining meticulous attention to detail (preferred).

• Experience with SystemOne (preferred).

🏝️ Benefits

• Clearly defined career paths and job levels.

• Opportunities for leadership development and virtual training.

• Paid time off and parental leave.

• Competitive 401K plan and employee benefits.

• Complimentary financial counseling, health coaching, and employee assistance programs.

• Tuition assistance program.

• Flexible work arrangements.

• Effective productivity and technology tools along with training.

• Eligibility for the Annual Incentive Program.

• Potential for long-term incentives and sales bonuses.

• Lincoln’s standard benefits package.