Appeals Case Manager II

Guardian Life; United States; Remote; USD 57,000 - 95,000; Full time

Job summary

An established industry player is on the lookout for a motivated Appeals Case Manager II to join their dynamic team. This role involves adjudicating appeals for Group Life and Disability claims, ensuring compliance with ERISA regulations. The ideal candidate will have a strong background in Group Disability claims, excellent communication skills, and the ability to manage multiple priorities. With a flexible work arrangement, this position offers a unique opportunity to contribute to a supportive and inclusive environment while advancing your career in the insurance sector.

Qualifications

• 5+ years of Group Disability and/or Life claims experience.
• 3+ years handling appeals or complex claims preferred.

Responsibilities

• Utilize effective claim management skills to resolve disputed claims.
• Evaluate medical and financial information for accurate appeal determinations.

Skills

Group Disability claims experience

Appeals handling

Analytical skills

Problem-solving skills

Communication skills

Education

Bachelor’s Degree

Job description

Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM2) 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 aredetail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude.

You have:

• A minimum of 5 years of Group Disability and/or Life claims experience.

• A minimum of 3 years of experience handling appeals or complex claims (preferred).

• Bachelor’s Degree (preferred) or equivalent professional experience.

• A client focus with excellent verbal and written communication skills.

• Strong problem-solving, analytical, math aptitude and information research skills.

• Demonstrated ability to manage multiple tasks in accordance with regulatory requirements.

• The ability to remain flexible due to changing business needs.

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 II, you will report to ourLeader, Appeals Team, who reports to our Leader, Group Claims Appeals & Compliance.

Location and Work Arrangement:

• Remote/Flexible – work primarily from home. May be expected to come into a Guardian work location occasionally, as determined by your people leader.

• Preference for candidates in close proximity to a Guardian hub office (Bethlehem, PA or Holmdel, NJ). Will consider applicants in other U.S. locations.

Travel

• Occasional (less than 10% of the time)

Salary Range:

$57,330.00 - $94,185.00

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.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. 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.

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.

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].

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.