Claims and Appeals Management

Consistent, efficient expertise

Ensuring unbiased and consistent review of eligibility and enrollment claims can completely overwhelm a Human Resources (HR) department with untold hours of staff time involved in researching cases, writing determination letters and communicating with employees.

Department of Labor (DOL) requirements call for an impartial first-level determination of eligibility and enrollment issues. Many HR departments don't have the in-house expertise needed to manage this process, creating a risk for DOL compliance questions.

Ensuring Compliance

Strict privacy laws further require that all claims be handled with utmost security and confidentiality to meet HIPAA regulations.

Alight's Claims and Appeals Management provides companies of all sizes with a highly trained team experienced in making objective determinations. Our Claims and Appeals Management team will use national guidelines in combination with specific plan rules, applying them consistently to ensure unbiased decisions.

The Alight team also taps expert resources to comply with DOL regulations and ERISA time frames, all within the strictest privacy standards.

Benefits of Alight Claims and Appeals Team:

Unbiased and consistent benefit determinations
Ensures DOL regulation and ERISA time frame compliance
Reduces HR department time on claims and appeals
Offers employee privacy and confidentiality protection
Provides consistent and documented responses
Summarizes comprehensive tracking and reporting of issues and trends

Level I and II Service

Alight serves Level I claims and Level II appeals related to eligibility and enrollment for group health and welfare, retirement and disability plans and spending account programs.

The Claims and Appeals Management team is integrated with other Alight benefit services, and thus can help identify trends and training opportunities specific to each organization. The team also provides aggregated data and detailed monthly reporting on concerns, complaints and participant needs.

The Alight Advantage

Experience- we process an average of 18,000 claims per year
Depth- we serve a wide variety of industries with team members who average more than five years in the field