Appeals Specialist

Job Classification: Operations - Insurance Operations Prudential's Group Insurance, Disability Claim Operation is seeking an experienced and highly motivated individual to join our team as a Short-Term Disability (STD) Sr. Appeals Analyst. This dynamic role requires the evaluation and management of a caseload of fully insured, administrative services, and advise to pay STD appeals. The position may also provide opportunities to identify trends, optimize organizational performance, provide feedback, support continuous improvement, and identify training opportunities. Role & Responsibilities Manage and assigned caseload of disability appeals. Utilize specialty resources effectively, including but not limited to internal and external clinical, vocational, and legal experts. Demonstrate industry leading customer service internally and externally. Administer and expertly apply contractual provisions. In a fast-paced environment, demonstrate excellent organizational and time management skills resulting in a well-balanced workflow. Exercise sound judgement in developing differentiated appeals plans that lead to optimal outcomes. Provide direct feedback as required to appropriate parties on claim handling. Identify opportunities for improved claim management across the organization. Qualifications 3-5 years of experience in stand-alone Short and/or Long-Term Disability claims required. Disability Appeals experience highly preferred. College Degree preferred. Working knowledge of ERISA appeal requirements, non-ERISA appeal considerations, and state-specific disability requirements. Demonstrated superior customer service skills. Excellent written and verbal communication skills. Strong analytical and critical thinking skills required. Demonstrate collaboration skills and ability to partner interdepartmentally. Ability to work independently and manager difficult interactions to resolution. Proficiency with claim systems, Microsoft Office applications, and documentation tools used to research, evaluate, and record claim and appeal activity. Aptitude to learn and integrate new technology into workflow. At Prudential, you can: Take charge of your career. We equip and empower our employees to expand their skills and experience by using powerful learning, gigs, and job opportunities. We offer a suite of services including 1:1 Career advice, on demand resources and networking to propel your career forward. We're a global organization, full of outstandingly dedicated people who aren't afraid to think differently, challenge the status quo and take sensible risks along the way. You will enjoy pushing boundaries as we build innovative technology that helps clients, customers and employees live their best lives. You will have access to leadership and learning opportunities and the resources needed to take your career in any direction. We will help you do your best work, offering flexibility, while delivering on our Purpose. What we offer you: Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $66,700.00 to $110,100.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills. Market competitive base salaries, with a yearly bonus potential at every level. Medical, dental, vision, life insurance, disability insurance, Paid Time Off (PTO), and leave of absences, such as parental and military leave. 401(k) plan with company match (up to 4%). Company-funded pension plan. Wellness Programs including up to $1,600 a year for reimbursement of items purchased to support personal wellbeing needs. Work/Life Resources to help support topics such as parenting, housing, senior care, finances, pets, legal matters, education, emotional and mental health, and career development. Education Benefit to help finance traditional college enrollment toward obtaining an approved degree and many accredited certificate programs. Employee Stock Purchase Plan: Shares can be purchased at 85% of the lower of two prices (Beginning or End of the purchase period). Eligibility to participate in a discretionary annual incentive program is subject to the rules governing the program, whereby an award, if any, depends on various factors including, without limitation, individual and organizational performance. To find out more about our Total Rewards package, visit Work Life Balance | Prudential Careers. Some of the above benefits may not apply to part-time employees scheduled to work less than 20 hours per week. Prudential Financial, Inc. of the United States is not affiliated with Prudential plc. which is headquartered in the United Kingdom. Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, national origin, ancestry, sex, sexual orientation, gender identity, national origin, genetics, disability, marital status, age, veteran status, domestic partner status, medical condition or any other characteristic protected by law. If you need an accommodation to complete the application process, please email View email address on click.appcast.io . If you are experiencing a technical issue with your application or an assessment, please email View email address on click.appcast.io to request assistance. #J-18808-Ljbffr