Short-Term Disability Auditor & Appeals Specialist
Job Number: NR815270511
Pay Rate: $32.85-38.85 / hour
Job Description
Short-Term Disability Auditor & Appeals Specialist:
Role Type: Part-Time (20 hours/week), Employee of the Company (Not a temp or contract assignment)
Shift: Day Job (Flexible schedule during EST business hours with consistent daily availability)
Work Arrangement: Remote, after training in Pittsburgh, PA 15219
Location: Remote / Pittsburgh, PA 15219
Salary Range: $32.85 – $38.85 USD
About the Opportunity
Our staffing firm is representing a permanent, part-time career opportunity. If selected, you will be hired directly as a regular employee of the organization we represent. You will be on their payroll and eligible for their benefits (pro-rated for part-time status) from your start date. This is not a temporary, contract, or "temp-to-hire" role.
Purpose
We are seeking a highly skilled professional to manage first-level Short-Term Disability (STD) appeals and perform critical quality reviews. This role is essential in ensuring that claims are handled with clinical and regulatory accuracy. As an Appeals Specialist, you will act as a key resource for the ERISA committee and provide feedback to management to drive ongoing training and process improvements.
Responsibilities
- Appeals Management: Maintain a caseload of appeal files; evaluate and investigate denied claims to determine if original decisions were appropriate.
- Regulatory Compliance: Ensure all appeals are processed in conformity with ERISA regulations, state laws, and company guidelines.
- Quality Auditing: Provide thorough audit reviews of appealed cases to the Department Manager for training and quality assurance purposes.
- Documentation & Communication: Investigations must be documented thoroughly. You will be responsible for writing complex, accurate decision letters to claimants or their representatives.
- Reporting: Monitor the inventory of STD appeals and provide comprehensive monthly reports and summaries of appeal decisions to management.
- Professional Representation: Serve as a subject matter expert and testify, as necessary, in legal proceedings regarding claim investigations.
Minimum Essential Requirements
- Bachelor’s Degree.
- Minimum of 5 years of disability claims management experience (Short-Term Disability preferred).
- 3 years of demonstrated experience specifically in a Short-Term Disability appeals environment.
- Expert Knowledge: Deep understanding of federal and state laws impacting disability management, including ERISA, ADA, FMLA, and FLSA.
- Communication Skills: Proven ability to write complex professional letters and communicate effectively in emotionally charged situations.
- Medical Literacy: Strong knowledge of ICD-10 (formerly ICD-9) and medical terminology.
- Self-Management: Must be self-motivated with the ability to handle multiple priorities and strict deadlines independently.
Performance-Based Earning Potential
This role offers a structured path for financial advancement. Through consistent high performance, leadership development, and continuous learning over time, employees have the opportunity to earn up to $56.83 per hour.
Premier Benefits
- Exceptional Retirement Package: Retirement plans including a 403(b) Savings Plan with employer matching and a Cash Balance Plan. Combined, the organization contributes up to 8% of your eligible pay toward your future.
- World-Class Healthcare: Access preventive care and specialty services through an exclusive provider network.
- Generous Paid Time Off: Enjoy up to 5.5 weeks of PTO per year (pro-rated), plus 7 paid holidays, with unique options to buy or sell PTO days to fit your lifestyle.
- Tuition Assistance: Benefit from up to $6,000 per academic year in tuition reimbursement, plus exclusive tuition discounts at over 30 partner colleges and universities.
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