Claims Case Manager II, Supplemental Health

Guardian Life; United States; Remote; USD 49,000 - 74,000; Full time

Job summary

Join a forward-thinking company as a Group Life/Supplemental Health Claims Case Manager II, where your analytical skills and problem-solving abilities will shine. This remote role involves making timely decisions on health and life claims, ensuring compliance with regulations while providing exceptional customer service. You'll gather information, evaluate cases, and communicate effectively with clients, all while contributing to a supportive and diverse workplace. If you're ready to grow your career in a role that values your expertise and offers flexibility, this opportunity is perfect for you.

Benefits

Skill-building Opportunities

Leadership Development

Community Involvement

Inclusive Benefits

Qualifications

• 2+ years experience adjudicating life claims.
• Knowledge of medical terminology is helpful.

Responsibilities

• Gather information and make claims decisions on health and life claims.
• Evaluate and resolve moderately complex cases effectively.

Skills

Analytical Skills

Problem-Solving

Communication Skills

Customer Service

Critical Thinking

Regulatory Compliance

Education

College Degree or Equivalent Experience

Tools

Microsoft Word

Microsoft Excel

Job description

The Group Life/Supplemental Health Claims Case Manager II is responsible for making timely and accurate decisions on assigned claims through proactive case management according to plan provisions, state and federal guidelines, and established protocols. This position primarily adjudicates Supplemental Health Claims but also handles Life Claims. The role requires problem-solving, analytical, written, and verbal communication skills to deliver prompt and appropriate life claim decisions while providing superior customer service to internal and external customers. The Claims Case Manager II manages claims across various group sizes, from small (2+ lives) to large (1000+ lives), and supports a range of Supplemental Health offerings, including Accident, Hospital Indemnity, Cancer, and Critical Illness. Additionally, the role involves supporting Life Claims, including Basic and Optional Group Life and complex AD&D Claims, ensuring compliance with plan provisions and eligibility requirements. The Life Claims Case Manager II consults with legal, investigative, and financial experts as needed.

New colleagues may receive up to three months of training, depending on experience. After training, the position involves making decisions on assigned claims within authority limits.

You are

Ready to grow your career by applying intellectual curiosity, proactively exploring new approaches, and demonstrating technical and functional competence and expertise!

You will

1. Gather investigation information, make claims decisions, and handle customer inquiries related to health, life, disability, annuities, AD&D, and critical illness claims.
2. Evaluate and resolve moderately complex cases using experience and guidelines, communicating resolutions effectively.
3. Use medical, financial, and other claim documents to inform adjudication, escalating issues as needed and following up to fill data gaps.
4. Document claim information, including process steps, provider numbers, services, and diagnosis codes, and review/approve claims of moderate complexity.
5. Communicate complex and sensitive information with customers, ensuring responses are responsive, empathetic, and customer-focused.
6. Apply critical thinking and investigative techniques to identify resources and make informed claim determinations.
7. Implement best practices and regulatory changes in case management, ensuring compliance with legal and regulatory standards.

You have

• A college degree or equivalent experience (preferred)
• At least 2 years' experience adjudicating life claims
• At least 1 year' experience supporting Supplemental Health claims (preferred)
• Experience in customer service roles and regulatory compliance (a plus)
• Knowledge of medical terminology (helpful)
• Strong math skills and proficiency in PC applications (e.g., Word, Excel)

Functional Skills

• Excellent communication skills (written and verbal)
• Independent and sound judgment
• Ability to analyze discrepancies and conduct research
• Strong time management and organizational skills
• Ability to multitask and prioritize effectively
• Self-motivated and able to work independently and collaboratively

Location

This is a remote position.

Salary Range: $49,160.00 - $73,737.50

The salary reflects a good faith estimate based on location and may be adjusted based on qualifications. Additional incentive compensation may be available.

Our Promise

At Guardian, you'll have support and flexibility to achieve your goals through skill-building, leadership development, and community involvement, all within a diverse and ethical environment.

Inspire Well-Being

Aligned with Guardian’s purpose, we offer inclusive benefits and resources. More details at our website. Benefits apply to full-time employees; interns are not eligible.

Equal Employment Opportunity

Guardian is an equal opportunity employer, considering all qualified applicants regardless of age, race, color, creed, religion, sex, sexual orientation, national origin, marital status, disability, military/veteran status, or other protected categories.

Accommodations

We provide access, equal opportunity, and reasonable accommodations for individuals with disabilities and medical conditions. To request accommodations, contact [e-mail].

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