Appeals Specialist- and Voluntary Product Claims; REMOTE

Job Description - Appeals Specialist - Life and Voluntary Product Claims (REMOTE) (2600000U)

Equitable

Full‑time

At Equitable, we help clients secure their financial well‑being so they can pursue long and fulfilling lives – a mission we’ve honed since 1859.

Equitable is seeking an influential and dynamic Appeals Specialist to join our Disability and Absence Claims organization. The Life Appeals and Complaints Specialist is responsible for managing and resolving complex insurance claims disputes and regulatory complaints. This role involves investigating appeals, regulatory complaints, drafting correspondence, and ensuring compliance with regulatory standards and company policies. The specialist will act as a liaison between the claims department, legal counsel, and policyholders as necessary.

• Handle and resolve complex insurance claims disputes efficiently.
• Investigate and analyze appeals to determine appropriate resolutions.
• Facilitate effective communication and resolution of disputes.
• Complaint Management:
  • Review and respond to regulatory complaints
  • Track and analyze trends for reporting
• Compliance and Standards:
  • Ensure compliance with all regulatory standards and internal company policies.
  • Stay updated on changes in insurance regulations and industry best practices.

• Maintain detailed records of all appeals and complaints.
• Analyze trends in claims disputes to recommend improvements in processes.

Regulatory and compliance requirements for this position allow remote work. Periodic office visits may be requested based on business needs.

The base salary range for this position is $50,000 – $65,000. Actual base salaries vary based on skills, experience, and geographical location. In addition to base pay, Equitable provides compensation to reward performance with base salary increases, spot bonuses, and short‑term incentive compensation opportunities. Eligibility for these programs depends on level and functional area of responsibility.

For eligible employees, Equitable provides a full range of benefits. This includes medical, dental, vision, a 401(k) plan, and paid time off.

• 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.

• Bachelor’s degree in Business, Healthcare Administration, or equivalent experience in a related field.
• Professional work experience in group insurance claims management or appeals.
• Prior experience with appeals, complaint handling or legal knowledge is beneficial.
• Excellent client relationship management skills.
• Strong verbal, written communication, and presentation skills.
• Comfortable dealing with complexity and ambiguity and able to explore multiple solutions.
• Previous experience with FINEOS Claims software platform is a big plus.

Claims Management: Comprehensive understanding of insurance policies, coverage terms, medical classification and claims adjudication procedures.

Legal Acumen: Familiarity with legal principles relevant to insurance disputes, including contract law, civil procedure, and regulatory requirements.

Effective Communications: Excellent written and verbal communication to effectively convey information to diverse audiences including legal professionals, policy holders and internal stakeholders.

Information Analysis and Interpretation: Ability to critically evaluate complex medical records, policy language and legal arguments to make informed decisions. Strong analytical and problem‑solving skills. Maintain accurate records of all cases in system of record.

At Equitable, we’re a team committed to helping our clients secure their financial well‑being so that they can pursue long and fulfilling lives.

We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in…