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Complex Sr. Appeal Specialist


Virtual, NJ
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Job Details

Position Title: Complex Sr. Appeal Specialist
Job Code: 419778
Job Location: New Jersey-Virtual

The Complex Senior Appeal Specialist is responsible for the highest level of technical support for Long Term Disability and Short Term Disability appeals.  This role provides technical expertise to the team and is accountable for optimal appeals handling and timely, accurate appeal determinations.  In this role you will use superior communication skills to independently assist internal and external customers with items including, but not limited to, problem resolution, education, application of complicated plan provisions. You will be expected to;

  • Utilize disability claim appeal management experience and expertise to guide lower level appeal analysts.
  • Provide mentoring and coaching to other appeals staff, and identifies trending data to provide feedback to appeals and claim operations staff.
  • Work with teams to address challenges relating to contract interpretation, procedures, and complex claim direction.
  • Communicate with clients, state insurance departments and other internal and external areas.
  • Manage difficult or complex situations to achieve appropriate outcomes, and negotiate settlement opportunities when appropriate.
  • May represent company in most complex mediations or depositions during litigation process.
  • Independently interact with internal customers including, but not limited to, attorneys, benefits administrators, SIU, account executives, account managers, underwriting, contracts, case installation, PDR and the tax team. May support leadership team to ensure performance objectives are met at a team level.  
  • Utilize reporting tools and claim reviews to support actions necessary to meet organizational objectives. 
  • Assess data and collaborate effectively across teams to elevate performance across functions.




  • A minimum of 5 years Appeals experience or Complex claim management in Long Term Disability
  • Exceptional claim/risk management skills and technical knowledge in contract interpretation and administration
  • Demonstrated success at coaching others to elevate performance
  • Demonstrated leadership skills in other position or similar position
  • Strong presentation and facilitation skills
  • Success in achieving Individual Development goals, and influence other’s in achieving development goals
  • Goal oriented with an ability to organize and analyze information
  • Strong critical thinking skills, communication, organization and time management skills
  • Proven customer service skills
  • Demonstrated ability to adapt to the changing needs of an organization
  • PC skills required (i.e., Windows based environment; Word; Excel; PowerPoint)
  • College degree preferred

Prudential is a multinational financial services leader with operations in the United States, Asia, Europe, and Latin America. Leveraging its heritage of life insurance and asset management expertise, Prudential is focused on helping individual and institutional customers grow and protect their wealth. The company's well-known Rock symbol is an icon of strength, stability, expertise and innovation that has stood the test of time. Prudential's businesses offer a variety of products and services, including life insurance, annuities, retirement-related services, mutual funds, asset management, and real estate services.

We recognize that our strength and success are directly linked to the quality and skills of our diverse associates. We are proud to be a place where talented people who want to make a difference can grow as professionals, leaders, and as individuals. Visit to learn more about our values, our history and our brand.

Prudential is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, genetics, disability, age, veteran status, or any other characteristic protected by law.

Note that this posting is intended for individual applicants. Search firms or agencies should email Staffing at for more information about doing business with Prudential.
Job Function: Claims
Schedule: Full-time
Apply on the Company Site
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