Appeals Case Manager II: Disability & Life Claims

Guardian Life; United States; Hybrid; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation package

Excellent medical, dental, vision and

401(k) with company match

Tuition assistance and parental leave

Flexible time off and remote/work-site

Employee Resource Groups

Job summary

Guardian Life seeks an experienced Appeals Case Manager II to adjudicate Group Disability and Life appeals under ERISA. The role involves thorough claim file review, plan interpretation and coordination with clinical/professional teams to reach fair determinations.

This mobile position supports Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, requiring strong analytical and communication skills and the ability to manage multiple priorities with minimal supervision.

Qualifications

• Minimum of 5 years of Group Disability and/or Life Claims experience.
• High School Diploma or GED required.
• 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 regulatory compliance.
• Flexibility and adaptability to changing business needs.

Responsibilities

• Plan, investigate and adjudicate disputed claims to provide timely, fair appeal determinations.
• Identify plan language and consult with clinical/vocational professionals as needed.
• Evaluate medical, financial and other claim information to resolve disputes.
• Provide proactive customer service to internal and external customers.
• Maintain knowledge of ERISA and Department of Labor guidelines and applicable regulations.
• Prioritize workload to meet deadlines and share insights with colleagues.

Skills

Group disability claims

Life claims

Verbal communication

Written communication

Analytical skills

Multitasking

Regulatory knowledge

Education

Bachelor's degree or equivalent experience

Job description

Guardian Life seeks an experienced Appeals Case Manager II to adjudicate Group Disability and Life appeals under ERISA. The role involves thorough claim file review, plan interpretation and coordination with clinical/professional teams to reach fair determinations.

This mobile position supports Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, requiring strong analytical and communication skills and the ability to manage multiple priorities with minimal supervision.