Claims Case Manager I, Supplemental Insurance

Guardian Life; Boise (ID); Remote; USD 40,000 - 62,000; Full time

Job summary

A leading insurance provider seeks a Claims Case Manager I for a remote role focusing on decision-making for Accident and Hospital Indemnity claims. This involves analyzing claims, determining coverage, and maintaining excellent customer communication. The ideal candidate has strong computer skills, decision-making abilities, and a knowledge of claims processing. Competitive salary range from $40,960 to $61,435 based on experience.

Benefits

Flexible work environment

Skill-building and leadership development opportunities

Diverse and inclusive company culture

Qualifications

• Claim processing experience preferred with knowledge of claims processes.
• Ability to demonstrate independent decision-making.
• Knowledge of Guardian’s Supplemental Health products preferred.

Responsibilities

• Investigate and analyze claim information for coverage and benefits.
• Review documentation to determine benefits against policy guidelines.
• Communicate claim status and decisions to claimants.

Skills

Computer skills (MS Word/Excel/PowerPoint)

Decision-making

Problem solving

Agility in handling multiple tasks

Communication skills

Education

College degree or equivalent work experience

Job description

As the Claims Case Manager I , Supplemental Insurance, you will be responsible for Accident and Hospital Indemnity claim decision making according to the plan provisions, state and federal guidelines, and established protocols. In a culture where “People Count,” “We Do the Right Thing,” and “We Hold Ourselves to Very High Standards, we are interested in individuals who are committed to customer satisfaction and an ability to make quick and accurate decisions for wellness benefits.

You are

• Ready to grow your career by applying intellectual curiosity while proactively looking at new and different ways of approaching work by displaying technical and functional competence, and expertise

• Able to demonstrate the ability to work independently and to make decisions; and possess the knowledge and experience which allows performance of daily activities of the job with minimal supervision

You will

• Investigate and analyze claim information to determine coverage and benefit eligibility, perform pre-existing condition investigation and draft adverse determination letter if applicable

• Review claim documentation to determine benefits available against policy guidelines. Once benefits established, determine corresponding type of service codes and benefit amounts for processing

• Assess file to determine if benefits are available under other product lines

• Utilize claim management resources, i.e. spreadsheets for various blocks of business, and other processing guidelines

• Proactively outreach to claimants, planholders, and physicians via telephone for information needed on initial and ongoing claim management (medical information, accident details, hospital services)

• Communicate claim status and decisions via telephone and in writing

• Prioritize and review new claims to adhere to established departmental turnaround times

• Meet productivity requirements as established by department for handling Supplemental Health Claims

You have

• Demonstrated computer skills with knowledge of MS Word/Excel/PP

• College degree preferred or equivalent work experience

• Claim processing experience preferred or working knowledge of claims processes

• Knowledge of Guardian’s Supplemental Health products, administration, and claims procedures, preferred

• Ability to problem solve systematic issues or changes based on standard and non-standard administration of claim benefits

• Agility in handling multiple tasks, responding rapidly to changing priorities, and working with tight deadlines

• Ability to keep the Voice of the Customer (VOC) forefront by demonstrating a proactive approach to problem solving or looking at continuous improvement

• Excellent decision making and communication skills

Location

This is a mobile (remote) position.

Salary Range:

$40,960.00 - $61,435.00

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.

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 .