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Appeals Analyst

Company: Reliance Standard
Location: Hawthorne
Posted on: June 8, 2021

Job Description:

Job Information

The Appeals Analyst is responsible for processing appeals of adverse benefit determinations in all lines of business, which includes Long Term Disability (LTD), Short Term Disability (STD), Life/Waiver of Premium/Group Life products/Accelerated Death/Accidental Death/Critical Illness (and all related coverages) or other claims.

Duties and Responsibilities:

  • Reviews, evaluates, and investigates (if necessary) in a timely manner consistent with applicable regulations and company guidelines adverse benefit determinations which have been properly appealed and determine whether the adverse benefit determination was appropriate.
  • Ensures the accuracy and timeliness of systems coding for the status of appealed adverse benefit determinations used in management reporting.
  • Supports the achievement of established departmental goals and objectives related to claim performance including service, quality and production.
  • Serves as a resource for all Claims personnel regarding the proper adjudication of claims and establishment of best claims practices.
  • Communicates the decision on appeal thoroughly and accurately in writing to the claimant or his/her authorized representative.
  • Provides appropriate feedback to Claims management and other team members for training purposes.
  • Develops and maintains strong working relationships with business partners including, but not limited to, underwriting, sales, actuarial and customer service.
  • Determines whether adverse benefit determinations have been properly appealed. All appeals should, where possible, be processed in conformity with (where applicable) the Employee Retirement Income Security Act of 1974 (ERISA) as amended and the accompanying regulations, state law and/or regulatory requirements, and in conformity with company guidelines.
  • Any other job-related duty as deemed appropriate by management.

Education, Qualifications and Experience:

  • High School Diploma or equivalent required.
  • Relevant Associates or Bachelors Degree highly preferred.
  • JD and/or the completion of HIAA, LOMA or ICA courses desirable.
  • Minimum of 5 years relevant experience.
  • Ability to deescalate difficult situations while displaying compassion and empathy.
  • Strong analytical skills focusing on accuracy and attention to details
  • Demonstrated ability to manage, prioritize and meet deadlines.
  • Demonstrated ability to provide feedback on Claims handling
  • Demonstrated ability to communicate effectively in person, on the telephone, and effectively in writing

Reliance Standard Insurance Company is an equal opportunity employer. Applicants are considered for positions without discrimination on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, veteran status or any other consideration made unlawful by applicable federal state or local laws.

Keywords: Reliance Standard, Yonkers , Appeals Analyst, Other , Hawthorne, New York

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