Job Description 

At Equitable, our power is in our people.  We're individuals from different cultures and backgrounds. Those differences make us stronger as a team and a force for good in our communities. Here, you'll work with dynamic individuals, build your skills, and unleash new ways of working and thinking. Are you ready to join an organization that will help unlock your potential?

Equitable is seeking an influential and dynamic Appeals and Complaints Team Leader to join our Disability and Absence Claims organization. The Appeals, Complaints, and Litigation team 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 team will act as a liaison between the claims department, legal counsel, and policyholders as necessary.

Key Job Responsibilities

• Claims Dispute Management:
  • Handle and resolve complex insurance claims disputes efficiently.
  • Investigate and analyze appeals to determine appropriate resolutions.
• Legal Documentation:
  • Prepare and review legal documentation related to claims disputes and appeals.
  • Collaborate with legal counsel to ensure all documentation meets legal standards.
• Compliance and Standards:
  • Ensure compliance with all regulatory standards and internal company policies.
  • Stay updated on changes in insurance regulations and industry best practices.
• Liaison Duties:
  • Act as a point of contact between the claims department, legal counsel, and policyholders.
  • Facilitate effective communication and resolution of disputes.
• Reporting and Analysis:
  • Maintain detailed records of all appeals and complaints.
  • Analyze trends in claims disputes to recommend improvements in processes.

The base salary range for this position is $90,000-$110,000. 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

Required Qualifications

·        5+ years of experience in the insurance industry, preferably in claims management or appeals.

·        Prior experience with litigation support or legal knowledge is beneficial.

·        3+ years of people leadership experience with excellent team management abilities

·        Specific experience with Group Insurance (Life, Short Term Disability, Long Term Disability and/or Paid/Unpaid Leaves)

Preferred Qualifications

·        Bachelor’s degree in Business, Law, Healthcare Administration, or a related field

·        Excellent client relationship management skills

·        Strong verbal, written communication, and presentation skills

·        Comfortable dealing with complexity and ambiguity and able to explore multiple solutions

·        Previous experience with FINEOS Claims software platform highly desired

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.

Leadership: In-depth knowledge of leadership practices and processes. Skilled in using strategies and techniques to inspire and guide internal claims teams towards achieving both short-term objectives and long-term goals. Ability to work independently and manage multiple tasks effectively. Strong analytical and problem-solving skills to identify issues, develop solutions and navigate challenging claim disputes.

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.

ABOUT EQUITABLE

At Equitable, we’re a team of over ten thousand strong; committed to helping our clients secure their financial well-being so that they can pursue long and fulfilling lives.

We turn challenges into opportunities by thinking, working, and leading differently – where everyone is a leader. We encourage every employee to leverage their unique talents to become a force for good at Equitable and in their local communities.

We are continuously investing in our people by offering growth, internal mobility, comprehensive compensation and benefits to support overall well-being, flexibility, and a culture of collaboration and teamwork.

We are looking for talented, dedicated, purposeful people who want to make an impact. Join Equitable and pursue a career with purpose.

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Equitable is committed to providing equal employment opportunities to our employees, applicants and candidates based on individual qualifications, without regard to race, color, religion, gender, gender identity and expression, age, national origin, mental or physical disabilities, sexual orientation, veteran status, genetic information or any other class protected by federal, state and local laws.

NOTE: Equitable participates in the E-Verify program.

If reasonable accommodation is needed to participate in the job application or interview process or to perform the essential job functions of this position, please contact Human Resources at (212) 314-2211 or email us at TalentAcquisition@equitable.com.