Appeals Case Manager II

Guardianlife; United States; Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

401(k) match

Excellent health coverage (medical, n

Dental and vision

Tuition assistance

Parental leave

Job summary

Guardian seeks an Appeals Case Manager II with extensive group disability and life claims experience to adjudicate and reconsider appeals under ERISA, ensuring fair outcomes and compliant resolutions.

The role supports disability and life claims appeals, requires independent prioritization, and ongoing knowledge of ERISA and DOL guidelines, with travel as needed.

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.

Responsibilities

• 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

Communication skills

Problem solving

Multi-tasking

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.
• Detail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude.

You have

• 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 and financial 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