Appeals Specialist- and Voluntary Product Claims; REMOTE

Employer Industry: Insurance

• Salary up to $65,000
• Performance-based incentives including base salary increases, spot bonuses, and short-term incentive compensation opportunities
• Comprehensive benefits package, including medical, dental, vision, a 401(k) plan, and paid time off
• Opportunity for career advancement and professional growth within the organization
• Supportive and collaborative work environment that encourages leveraging unique talents

• Manage and resolve complex insurance claims disputes effectively
• Investigate appeals and regulatory complaints to determine appropriate resolutions
• Facilitate communication between claims department, legal counsel, and policyholders
• Ensure compliance with regulatory standards and internal company policies
• Maintain detailed records of all appeals and complaints while analyzing trends for reporting

• 3+ years of professional work experience in the insurance industry
• Experience with Group Insurance Claims (Life, Short Term Disability, Long Term Disability, and/or Paid/Unpaid Leaves)
• Previous experience with Department of Insurance Complaint handling
• Strong verbal and written communication skills
• Ability to critically evaluate complex medical records and legal arguments

• Bachelor’s degree in Business, Healthcare Administration, or a related field
• Professional experience in group insurance claims management or appeals
• Familiarity with FINEOS Claims software platform
• Excellent client relationship management skills
• Comfortable dealing with complexity and ambiguity