Senior Appeals Analyst - LTD

Job Classification:

Operations - Insurance Operations

Prudential’s Group Insurance, Disability Claim Operation is seeking an experienced and highly motivated individual to join our team as a Long-Term Disability (LTD) Sr. Appeals Analyst. This dynamic role requires the evaluation of disability claim appeals and the management of a caseload of complex appeals. The position may also provide opportunities to identify trends, optimize organizational performance, provide feedback, support continuous improvement, and identify training opportunities.

Roles & Responsibilities

Manage and assigned caseload of complex disability appeals.

Utilize specialty resources effectively, including internal and external clinical, vocational, and legal experts.

Demonstrate industry leading customer service internally and externally.

Administer and expertly apply contractual provisions.

Demonstrate excellent organizational and time management skills resulting in a well-balanced workflow.

Exercise sound judgement in developing differentiated appeals plans that lead to optimal outcomes.

Provide direct feedback on claim handling as required to appropriate parties.

Identify opportunities for improved claim management across the organization.

Qualifications

• 3-5 years of experience in stand-alone Long Term Disability claims required.
• Disability Appeals experience highly preferred.
• Experience with Short Term Disability and Life Waiver of Premium claims preferred.
• College Degree preferred.
• Working knowledge of ERISA appeal requirements, non-ERISA appeal considerations, and state-specific disability requirements.
• Demonstrated superior customer service skills.
• Excellent written and verbal communication skills.
• Strong analytical and critical thinking skills required.
• Demonstrate collaboration skills and ability to partner interdepartmentally.
• Ability to work independently and manager difficult interactions to resolution.
• Proficiency with claim systems, Microsoft Office applications, and documentation tools used to research, evaluate, and record claim and appeal activity.
• Aptitude to learn and integrate new technology into workflow.

What we offer you:

Prudential is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $66,700.00 to $110,100.00. Specific pricing for the role may vary within the above range based on many factors including geographic location, candidate experience, and skills. Market competitive base salaries, with a yearly bonus potential at every level.