Lincoln Financial Group Appeals Specialist in Sacramento, California
Alternate Locations: Work from Home
Hybrid/Flexible : Work at home and use the office as appropriate for in-person collaboration.
Relocation assistance: is not available for this opportunity.
Requisition #: 72397
The Role at a Glance
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.
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!
What you'll be doing
You will analyze & process claims by investigating & obtaining a wide range of complex information. Apply claim policies & procedures and engages intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims
You will analyze and interpret complex coverage contracts to determine if eligibility is met.
You will identify and resolve gaps in financial calculations and offsets when applicable, share technical knowledge and approach on financial calculations with team members.
You will interpret calculations correctly involving complex contract provisions and work with applicable resources as needed to resolve issues.
You will 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.
You will provide customers with in-depth explanations of policy details, claim process, and claim determination; ensure parties understand the information and outcome.
You will utilize internal reporting to identify trends and review/audit performance against team metrics; propose and develop practices & processes to improve performance and the customer experience.
You will effectively utilize and implement policies & procedures regarding medical terminology, duration, functionality documentation, and overall claims workflow. Provide detailed guidance & coaching to junior team members.
What we’re looking for
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
Competitive 401K and employee benefits (https://hrdirectdocs.lfg.com/misc/HR/Recruiting/BenefitsResourcesGuide.pdf)
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 helps people to plan, protect and retire with confidence. As of Dec. 31, 2022, approximately 16 million customers trust our guidance and solutions across four core businesses – annuities, life insurance, group protection and retirement plan services. As of September 30, 2023, the company had $290 billion in end-of-period account balances, net of reinsurance. Headquartered in Radnor, Pa., Lincoln Financial Group is the marketing name for Lincoln National Corporation (NYSE: LNC) and its affiliates. Learn more at LincolnFinancial.com.
Lincoln is committed to creating a diverse and inclusive (https://www.lfg.com/public/aboutus/companyoverview/diversityinclusion?audience_page_id=1422918942386) 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.
Follow us on Facebook (http://www.facebook.com/lincolnfinancialgroup) , Twitter (https://mobile.twitter.com/lincolnfingroup) , LinkedIn (https://www.linkedin.com/company/4307?trkInfo=tas%3Alincoln+financial%2Cidx%3A3-1-3&trk=tyah) , and Instagram (https://www.instagram.com/lincolnfingroup/) . Sign up for email alerts at http://newsroom.lfg.com
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@example.com if you encounter a recruiter or see a job opportunity that seems suspicious.
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.
This Employer Participates in E-Verify. See the E-Verify (https://www.e-verify.gov) notices.
Este Empleador Participa en E-Verify. Ver el E-Verify (https://www.e-verify.gov/es) avisos.
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, veterans status, or genetic information. Opportunities throughout LFG are available to employees and applicants and are evaluated on the basis of job qualifications. We have a drug free work environment and we perform pre-employment substance abuse testing.
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