- Salary
- $66.1K–$110.1K
- Hiring from
- United States
- Work type
- Remote
- Posted
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Symetra offers a thrilling chance to become part of our team as a Senior Appeals Specialist!
About the role
The Appeals Specialist uses in-depth knowledge of Short Term Disability, Long Term Disability, Life, and Waiver of Premium claims processing to conduct thorough appeals reviews of terminated or denied claims and render an appeal decision. The Appeals Specialist follows department established guidelines and workflows and also adheres to ERISA and other regulatory guidelines and timeframes to prevent risk of penalties/fines. The Appeals Specialist will also work with the Compliance department to handle and respond to complaints filed on claims.
What you will do
- Appeals - Review appealed claims in accordance with appropriate Short Term Disability, Long Term Disability, or Life plan/policy provisions. - Develop action plans for handling appealed claims. - Implement action plans for appealed claims, which includes: contacting claimant/claimant representatives (such as attorneys) to discuss the case; contacting providers to obtain medical information; contacting employers to obtain information; and requesting medical/vocational review. - Utilize tolling and extensions when appropriate during the course of appeal reviews. - Determine appropriate type of specialty review required (vocational or medical specialty and type of review needed - peer review, IME, Occupational and/or Employability Assessment, etc) and develop specific questions to be addressed to render an accurate appeal decision. - Resolve appeals timely (within mandated timeframes) and communicate appeal outcomes to appropriate parties. - Identify trends noted through appeal reviews and communicate trends to Management team for addition developmental opportunities for staff.
- Complaints - Work with Compliance in handling and responding to complaints filed on claims, including those filed through state insurance departments, executive and presidential complaints, etc. - Create/maintain recordkeeping of new and ongoing complaint activity in required systems through to the resolution and closure of the complaint. - Maintain communications with appropriate parties related to all complaint activity. - Research and compile data and provide a drafted response to the complaint with supporting documentation for review to Compliance Officer, and Law Department when appropriate. - Send final response to complaint to appropriate party within the required timeframes. - Monitor complaints for follow-up requests and ongoing activity.
Why Work at Symetra
Here’s what some of our employees share about why they choose to work at Symetra:
“I truly believe there’s something for everyone at Symetra. No matter what your passion is, if you enjoy being part of something bigger than yourself and want to make a meaningful difference, this is the place for you. We’re more than just an insurance company—we’re a community with purpose.” - Joanne S., AVP Compliance
"If given an opportunity to work for this amazing company-say yes! You will not be disappointed." - Rebecca A., Sr. Medical Risk Consultant
What we offer you
Benefits and Perks
We don’t take a “one-size-fits-all” approach when it comes to our employees. Our programs are built to make your life better both at work and at home.
- Flexible full-time or hybrid telecommuting arrangements.
- Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6%.
- Paid time away including vacation and sick time, flex days and ten paid holidays.
- Give back to your community and double your impact through our company matching.
- Want more details? Check out our Symetra Benefits Overview.
Compensation
Salary Range: $66,100 - $110,100 plus eligibility for annual bonus program.
Who You Are
- High school diploma or equivalent work experience, college degree a plus.
- 5-8 years of cumulative, relevant experience.
At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute.
Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products--and operate our company--to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom.
Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company.
- Minimum Internet Speed:100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband."
- Internet Type:Fiber, Cable (e.g., Comcast, Spectrum), or DSL.
- Not Permissible:Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up.
- Disqualification from the recruitment process
- Withdrawal of a job offer
- Termination of employment and other criminal and/or civil remedies, if fraud is discovered
