Appeals Specialist, Virtual

Company Name:
Title: Appeals Specialist, Virtual
Location: Maine-Portland
Other Locations: United States-New Jersey-Roseland, United States-Arizona-Scottsdale, United States
The Appeals Specialist is responsible for providing the highest level of technical review & payment authorization for the most complex of Long Term Disability (LTD) appeals. This is done by utilizing appeal claim/risk management experience and specialty resources effectively (medical & vocational) to achieve optimum outcomes for claim direction. Specific responsibilities include, but are not limited to:
Effectively managing through a caseload with mostly complex appeals
Providing technical direction to other appeals personnel as needed and may serve as a mentor/coach
Monitoring workloads, tracking metric results, reviewing authority referrals, or completing quality audits, as needed
Interacting with internal and external customers including, but not limited to claimants, employers, physicians and attorneys
Representing Prudential at settlements or mediations and/or negotiating settlements on appeals, as needed
Independently participating in client meetings or conference calls regarding claim handling.
This position could be in any of the following locations:
Virtual work from home opportunity anywhere in the US
Portland, ME office location
Roseland, NJ office location
Scottsdale, AZ office location
A minimum of 3-4 years of complex claim experience (appeals or complex claim team) is required, along with the following:
Exceptional claim/risk management skills and technical knowledge in contract interpretation and administration
Demonstrated success at coaching others to elevate their performance
Goal oriented with an ability to organize and analyze information to ensure objectives are met
Strong critical thinking, written/verbal communication, organization and time management skills
Strong customer service skills proven through internal and external customer interactions
Proven ability to partner with various areas of an organization

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