Company: Reliance Standard
Posted on: June 8, 2021
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
- Ensures the accuracy and timeliness of systems coding for the
status of appealed adverse benefit determinations used in
- Supports the achievement of established departmental goals and
objectives related to claim performance including service, quality
- Serves as a resource for all Claims personnel regarding the
proper adjudication of claims and establishment of best claims
- Communicates the decision on appeal thoroughly and accurately
in writing to the claimant or his/her authorized
- 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
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
- 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
- Demonstrated ability to manage, prioritize and meet
- Demonstrated ability to provide feedback on Claims
- 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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