Appeals Case Manager II

Guardian Life; Northern (KY); Hybrid; USD 59,000 - 96,000; Full time

Benefits offered by this job

Medical and dental coverage

Vision coverage

Life and disability insurance

401(k) with company match

Tuition assistance

Parental leave

Flexible time off

Job summary

Guardian Life is seeking an Appeals Case Manager II with group disability claims experience to adjudicate and reconsider appeals for group life and disability benefits under ERISA. The role supports short- and long-term disability and life waiver of premium appeals, working independently or with supervision as needed.

The ideal candidate will have strong analytical skills, excellent communication, and the ability to manage multiple priorities while ensuring regulatory compliance.

Qualifications

• High School Diploma or GED required.
• Minimum of 5 years of Group Disability and/or Life Claims experience.
• Strong client focus with excellent verbal and written communication skills.
• Ability to manage multiple priorities while ensuring regulatory compliance.
• Preferred: 3+ years handling appeals and/or complex claims.

Responsibilities

• Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution.
• Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination.
• Evaluate medical, financial and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.
• Utilize proactive outreach to provide superior customer service to all internal and external customers.
• Identify legal and/or compliance scenarios that require additional research; facilitate resolution.
• Maintain current knowledge of all ERISA and Department of Labor guidelines.
• Independently prioritize workload based on individual and departmental deadlines.
• Readily share insights and learnings with claims colleagues.

Skills

Disability claims

Claims adjudication

ERISA knowledge

Communication skills

Analytical skills

Education

High School Diploma or GED

Bachelor's degree (preferred)

Job description

Position Summary: Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM 2) is responsible for adjudicating assigned appeals for Group Life and Disability claims. The ACM 2 provides a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations. This role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.**You are**A highly motivated and reliable individual who is able to work with varying levels of supervision – independently or collaboratively. You are detail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude. **You have** Required Qualifications* High School Diploma or GED required.* Minimum of 5 years of Group Disability and/or Life Claims experience.* Strong client focus with excellent verbal and written communication skills.* Demonstrated problem-solving, analytical, mathematical, and research skills.* Ability to manage multiple priorities and tasks while ensuring compliance with applicable regulatory requirements.* Flexibility and adaptability in response to changing business needs. Preferred Qualifications* Minimum of 3 years of experience handling appeals and/or complex claims.* Bachelor's degree or equivalent combination of education and professional experience.**You will*** Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution.* Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination.* Evaluate medical, financial and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.* Utilize proactive outreach to provide superior customer service to all internal and external customers.* Identify legal and/or compliance scenarios that require additional research; facilitate resolution.* Maintain current knowledge of all ERISA and Department of Labor guidelines.* Independently prioritize workload based on individual and departmental deadlines.* Readily share insights and learnings with claims colleagues.**Reporting Relationships**As our Appeals Case Manager 2, you will report to our Leader - Appeals Team, who reports to our Leader – Group Claims Appeals & Compliance. **Location & Vaccination Requirements**This is a mobile position where preference may be given to candidates within commuting proximity to a Guardian office with the ability to travel to Guardian offices as determined by the People Leader.**Travel**Occasional 0-10% of the time. **Our promise*** Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards**We offer*** Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.* Competitive compensation package.* Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.* Life and disability insurance.* A great 401(k) with company match.* Tuition assistance paid parental leave and backup family care.* Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.* Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.* Employee Resource Groups that advocate for inclusion and diversity in all that we do.* Social responsibility in all aspects of our work. We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.**Company Descriptions for Postings:****About Guardian**Guardian has been helping people protect their futures and secure their lives for 160 years. Every day, we serve approximately 29 million people through a range of insurance and financial products. We help people and their families pursue financial security and well-being in life, health, and wealth. We help companies take care of their employees. And we help people recover and thrive after unexpected loss.From our founding in 1860, when a community of immigrants joined together to insure and protect their businesses and families, doing the right thing for our policyholders and customers has guided everything we do. Our dedication to customers has helped us remain one of the most highly rated in client satisfaction andfinancial strength. And as one of the largest mutual insurance companies, we know what matters most: putting the needs of our customers first. Because everyone deserves a Guardian. Learn more about Guardian at www.GuardianLife.com. Copyright 2021 The Guardian Life Insurance Company of America, New York, NY**Equal Employment Opportunity**Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.**About ReedGroup**As the largest exclusive provider of absence management services, ReedGroup has been dedicated to helping employees return to work safely for more than 35 years. We create a seamless experience so clients can excel at their jobs and better serve their employees – supporting a thriving, engaged, and skilled workforce.ReedGroup is a wholly-owned, independent subsidiary of The Guardian Life Insurance Company – providing even more ways we can better serve people. Guardian has been helping people protect their futures and secure their lives for more than 150 years, and today serves 27 million people by helping them find financial confidence and well-being in life, health, and wealth. And as one of the largest mutual insurance companies, we know what matters most: putting the needs of customers first.**Equal Employment Opportunity**Reed is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.**Salary Range:**$58,620.00 - $96,300.00The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.