Appeals Case Manager II

The Guardian Life Insurance Company of America; United States; Hybrid; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation package

Excellent health coverage

401(k) with company match

Tuition assistance and parental leave

Flexible time off

Job summary

The Guardian Life Insurance Company of America is seeking an Appeals Case Manager II with group disability experience to adjudicate appeals for life and disability claims. This mobile role involves evaluating plan language, coordinating with clinical professionals, and ensuring timely, compliant resolutions under ERISA guidelines.

Reporting to the Leader - Appeals Team, you will manage multiple priorities, provide excellent customer service, and stay current with regulatory requirements while

Qualifications

• 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 complying with regulatory requirements.

Responsibilities

• Plan, implement and execute the investigation of disputed claims and ensure timely, compliant appeal resolution.
• Identify and interpret relevant plan language and investigate all claim issues to make an accurate appeal determination.
• Evaluate medical, financial and other information with clinical/vocational input as needed.
• Provide proactive outreach to deliver excellent customer service to internal and external customers.
• Identify legal/compliance scenarios requiring additional research and facilitate resolution.
• Maintain current knowledge of ERISA and Department of Labor guidelines.
• Prioritize workload independently based on deadlines and team needs.
• Share insights with claims colleagues to improve processes.

Skills

Group disability/life claims

Verbal and written communication

Problem solving and analytical skills

Regulatory compliance knowledge

Multitasking and prioritization

Adaptability and flexibility

Education

High School Diploma or GED

Bachelor’s degree or equivalent experience

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.

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.

Responsibilities

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. Inspire Well-Being As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues. Explore our company benefits at www.guardianlife.com/careers/corporate/benefits. Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Benefits

• 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 www.GuardianLife.com.

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 servepeople. 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.

Salary Range

Salary Range: $58,620.00 - $96,300.00. The 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.

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.

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.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [e-mail]. Please note: this resource is for accommodation requests only. For all other inquiries related to your application and careers at Guardian, refer to the Guardian Careers site.

Visa Sponsorship

Guardian Life is not currently or in the foreseeable future sponsoring employment-based visas (e.g., such as an H-1B). In order to be a successful applicant, you must be legally authorized to work in the United States, without the need for employer sponsorship/support now or at any time in the future.

Notice Regarding Guardian’s Use of Artificial Intelligence in Recruitment

As part of Guardian’s job application process, Guardian may use artificial intelligence tools (\"AI Tools\") to automate the sorting and filtering of information provided by applicants as part of its preliminary screening. This preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian’s jobs website (Careers at Guardian at https://www.guardianlife.com/careers). At Guardian, we do not use AI Tools to substantially assist or replace human judgment or discretionary decision making in our hiring process. All hiring decisions will be made by Guardian colleagues. Please be aware that if you apply for a specific position with Guardian, you will have the choice of opting out of Guardian’s use of AI Tools during the job application process. If you would like to request an alternative process that does not utilize AI Tools or would like to request a reasonable accommodation, within ten business days of your position application, you must email your request to [e-mail], making sure to provide your name and job requisition identification number. Guardian will retain your applicant materials and resume and all information therefrom in accordance with Guardian’s document retention policy, a copy of which you may request via [e-mail]. Additionally, at applicable times, Guardian will make public the most recent bias audit results for such AI tools, which may be found here.

Current Guardian Colleagues

Current Guardian Colleagues: Every day, Guardian helps our 29 million customers realize their dreams through a range of insurance and financial products and services. Our Purpose, to inspire well-being, guides our dedication to the colleagues, consumers, and communities we serve. We know that people count, and we go above and beyond to prepare them for the life they want to live, focusing on their overall well-being — mind, body, and wallet. As one of the largest mutual insurance companies, we put our customers first. Behind every bright future is a GuardianTM. Learn more about Guardian at guardianlife.com.