Appeals Specialist

Working remotely in a full-time capacity, the Appeals Specialist will leverage expertise in claims adjudication and risk management to guide clients through the appeals process, ensuring compliance and effective communication with stakeholders. Key responsibilities Reviews and evaluates benefit determination materials for various appeals, overcoming objections and clarifying issues as needed Renders appeal decisions using medical, vocational, and legal resources, serving as a technical expert in client appeal activities Prepares professional written communications and maintains accurate records of appeal causes and dispositions Required qualifications At least 8 years of direct Group Disability industry experience with a strong understanding of claims adjudication and contract interpretation Demonstrated high-level risk management and analytical skills, along with the ability to interpret and communicate disability contract language Experience conducting presentations and collaborating with legal teams, including participation in depositions or trials Ability to manage multiple priorities effectively and de-escalate situations regularly Access to high-speed internet and located in the United States or Puerto Rico