Alternate Locations: Work from Home
Work Arrangement:
Hybrid/Flexible : Work at home and use the office as appropriate for in-person collaboration.
Relocation assistance: is not available for this opportunity.
Requisition #: 72164
We are excited to bring on an Appeals Specialist to join our Appeal Review Department in a fully remote environment. Appeal Specialists conduct reviews, investigation, and analysis of an assigned caseload of Short-Term Disability appeals. The role is responsible for interpreting and applying correct contract terms/provisions, ERISA requirements, statutory guidelines, and case management and appeal procedures to each claim.
Background Details
As an Appeals Specialist you will be responsible for being a product subject matter expert to provide full, fair appeal reviews for multiple product lines. You will perform and deliver on appeals claims assignments/projects while simultaneously leveraging and applying knowledge. You will analyze and manage a caseload of appeals claims. You will review, investigate, and make claim determinations regarding coverage, compensability, and appropriateness of
claims. You will provide technical information and detailed guidance to Claims management & teams regarding products, claims processes, regulations, and applicable systems for their assigned claims area.
If this sounds like a role for you, please read on!
- Analyzes & processes claims by investigating & obtaining a wide range of complex information. Applies claims policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims
- Analyzes and interprets complex coverage contracts to determine if eligibility is met.
- Identifies and resolves gaps in financial calculations and offsets when applicable, shares technical knowledge and approach on financial calculations with team members.
- Interprets calculations correctly involving complex contract provisions and works with applicable resources as needed to resolve issues.
- Understands and reinforces to junior team members the importance of correct and accurate eligibility decisions and benefit calculations.
- Research questions and escalations from Claims team; liaises with various stakeholders from across the business (Underwriting, Actuarial, Compliance, Account Management, etc.) to obtain needed information to clarify and address issues.
- Provides customers with in-depth explanations of policy details, claim process, and claim determination; ensures parties understand the information and outcome.
- Utilizes internal reporting to identify trends and review/audit performance against team metrics; proposes and develops practices & processes to improve performance and the customer experience.
- Effectively utilizes and implements policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims workflow. Provides detailed guidance & coaching to junior team members.
Must-have experience (Required):
- 4 Year/Bachelor's degree or equivalent work experience (4 years of experience in lieu of Bachelor's)
- 1 - 3+ Years of claims experience directly aligned to the specific responsibilities for this role. (Required)
- Ability to communicate effectively (verbal/written)
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook)
Nice-to have Experience (Preferred):
- Experience working with multiple products
- Presentation training or skills
- Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail.
What’s it like to work here?
At Lincoln Financial Group, we love what we do. We make meaningful contributions each and every day to empower our customers to take charge of their lives. Working alongside dedicated and talented colleagues, we build fulfilling careers and stronger communities through a company that values our unique perspectives, insights and contributions and invests in programs that empower each of us to take charge of our own future.
What’s in it for YOU:
A clearly defined career framework to help you successfully manage your career
Leadership development and virtual training opportunities
PTO/parental leave
Competitive 401K and employee benefits
Free financial counseling, health coaching and employee assistance program
Tuition assistance program
A leadership team that prioritizes your health and well-being; offering a remote work environment and flexible work hybrid situations
Effective productivity/technology tools and training
Pay Range: $51,900 - $89,800
Actual base pay could vary based on non-discriminatory factors including but not limited to work experience, education, location, licensure requirements, proficiency and qualifications required for the role. The base pay is just one component of Lincoln’s total rewards package for employees. In addition, the role may be eligible for the Annual Incentive Program, which is discretionary and based on the performance of the company, business unit and individual. Other rewards may include long-term incentives, sales incentives and Lincoln’s standard benefits package.
About The Company
Lincoln Financial Group, a Fortune 200 company with over 10,000 employees, provides advice and solutions that help empower Americans to take charge of their financial lives with confidence. Our core business areas — Life Insurance, Annuities, Retirement Plan Services and Group Protection — focus on supporting, preserving and enhancing over 17 million customer’s lifestyles and retirement outcomes.
Headquartered in Radnor, Pennsylvania, Lincoln Financial Group is the marketing name for Lincoln National Corporation (NYSE: LNC) and its affiliates. The company had $324 billion in end-of-period account values as of June 30, 2021.
Ranked one of the Best Large Employers in America and Best Employers for Women by Forbes magazine as well as one of Newsweek’s Most Responsible Companies, Lincoln Financial Group makes a serious investment in our employees’ futures through a broad range of wealth accumulation and protection plans, health and wellness programs, and career development resources designed to help each individual reach their personal and professional goals.
Lincoln is committed to creating a diverse and inclusive environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
Lincoln Financial Group is a committed corporate citizen included on major sustainability indices including the Dow Jones Sustainability Index North America and FTSE4Good. Dedicated to diversity and inclusion, we earned perfect 100 percent scores on the Corporate Equality Index and the Disability Equality Index. Follow us on Facebook, Twitter, LinkedIn, and Instagram.
Be Aware of Fraudulent Recruiting Activities
If you are interested in a career at Lincoln, we encourage you to review our current openings and apply on our website. Lincoln values the privacy and security of every applicant and urges all applicants to diligently protect their sensitive personal information from scams targeting job seekers. These scams can take many forms including fake employment applications, bogus interviews and falsified offer letters.
Lincoln will not ask applicants to provide their social security numbers, date of birth, bank account information or other sensitive information in job applications. Additionally, our recruiters do not communicate with applicants through free e-mail accounts (Gmail, Yahoo, Hotmail) or conduct interviews utilizing video chat rooms. We will never ask applicants to provide payment during the hiring process or extend an offer without conducting a phone, live video or in-person interview. Please contact Lincoln's fraud team at
[email protected] if you encounter a recruiter or see a job opportunity that seems suspicious.
Additional Information
This position may be subject to Lincoln’s Political Contribution Policy. An offer of employment may be contingent upon disclosing to Lincoln the details of certain political contributions. Lincoln may decline to extend an offer or terminate employment for this role if it determines political contributions made could have an adverse impact on Lincoln’s current or future business interests, misrepresentations were made, or for failure to fully disclose applicable political contributions and or fundraising activities.
Any unsolicited resumes/candidate profiles submitted through our web site or to personal e-mail accounts of employees of Lincoln Financial Group are considered property of Lincoln Financial Group and are not subject to payment of agency fees.
Lincoln Financial Group (“LFG”) is an Equal Opportunity employer and, as such, is committed in policy and practice to recruit, hire, compensate, train and promote, in all job classifications, without regard to race, color, religion, sex (including pregnancy), age, national origin, disability, sexual orientation, gender identity and expression, Veteran status, or genetic information. Applicants are evaluated on the basis of job qualifications. If you are a person with a disability that impedes your ability to express your interest for a position through our online application process, or require TTY/TDD assistance, contact us by calling 260-455-2558.
