Disability Claims Appeal & Complaints Analyst (REMOTE)
About the position
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 Disability Claims Appeal & Complaints Analyst to join our Disability and Absence Claims organization. The Disability Claims Appeal & Complaints Analyst is responsible for managing and resolving complex insurance claims disputes. This role involves investigating appeals, preparing applicable legal documentation, and ensuring compliance with regulatory standards and company policies. The Analyst will act as a liaison between the claims department, legal counsel, and policyholders as necessary.
This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours (8:30 AM–5:30 PM EST). 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. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
Responsibilities
• Analyst will handle appeals submitted on Disability (STD, LTD, Leave) products.
• Review adverse claim life decisions within STD, LTD, State Leave product line.
• Review claim files in depth and detail to determine if previous claim decision (adverse claim decision) was appropriate or if prior decision should be reversed.
• Provide high level feedback on claim handling.
• Handle appeals in line with job aids in place.
• Responsible for reviewing regulatory & presidential complaints and providing responses to appropriate agency.
Requirements
• Prior claim handling experience in fully and self-insured STD, LTD and State Leave lines of business.
• Prior Appeal handling experience in fully/self insured STD, LTD, State Leave lines of business including decision letter writing.
• Prior Complaint handling experience (regulatory, Sr. Officer, Presidential).
• Contract review and interpretation.
• Letter writing skills.
• 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.
Nice-to-haves
• FINEOS experience is preferred
• Microsoft office products
• Excel experience/knowledge
• PowerPoint experience
Benefits
• medical
• dental
• vision
• a 401(k) plan
• paid time off
Apply tot his job
Apply To this Job
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 Disability Claims Appeal & Complaints Analyst to join our Disability and Absence Claims organization. The Disability Claims Appeal & Complaints Analyst is responsible for managing and resolving complex insurance claims disputes. This role involves investigating appeals, preparing applicable legal documentation, and ensuring compliance with regulatory standards and company policies. The Analyst will act as a liaison between the claims department, legal counsel, and policyholders as necessary.
This position offers a remote work schedule that allows you to stay fully engaged with your team to provide outstanding, customer‑focused service during our core hours (8:30 AM–5:30 PM EST). 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. For detailed descriptions of these benefits, please reference the link below.
Equitable Pay and Benefits: Equitable Total Rewards Program
Responsibilities
• Analyst will handle appeals submitted on Disability (STD, LTD, Leave) products.
• Review adverse claim life decisions within STD, LTD, State Leave product line.
• Review claim files in depth and detail to determine if previous claim decision (adverse claim decision) was appropriate or if prior decision should be reversed.
• Provide high level feedback on claim handling.
• Handle appeals in line with job aids in place.
• Responsible for reviewing regulatory & presidential complaints and providing responses to appropriate agency.
Requirements
• Prior claim handling experience in fully and self-insured STD, LTD and State Leave lines of business.
• Prior Appeal handling experience in fully/self insured STD, LTD, State Leave lines of business including decision letter writing.
• Prior Complaint handling experience (regulatory, Sr. Officer, Presidential).
• Contract review and interpretation.
• Letter writing skills.
• 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.
Nice-to-haves
• FINEOS experience is preferred
• Microsoft office products
• Excel experience/knowledge
• PowerPoint experience
Benefits
• medical
• dental
• vision
• a 401(k) plan
• paid time off
Apply tot his job
Apply To this Job