Remote Appeals Case Manager II

Guardian Life; Annapolis (MD); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

401(k) with company match

Tuition assistance

Parental leave

Flexible time off

Job summary

Guardian Life is seeking experienced Appeals Case Managers to adjudicate Group Life and Disability claim appeals under ERISA. This role supports short-term/long-term disability and life waiver appeals, with remote/mobility aspects and occasional travel.

The ACM 2 uses plan language, medical and financial information, and professional guidance to render fair, accurate appeal determinations while maintaining high service standards.

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.

Responsibilities

• Plan, investigate and resolve disputed claims; ensure timely, compliant appeal resolution.
• Identify and interpret relevant plan language; thoroughly investigate all claim issues for fair determinations.
• Evaluate medical and financial information with clinical/vocational input to resolve disputes.
• Provide proactive outreach and superior customer service to internal and external customers.
• Identify legal/compliance scenarios requiring additional research; facilitate resolution.
• Maintain knowledge of ERISA and Department of Labor guidelines.
• Prioritize workload to meet deadlines; share insights with colleagues.

Skills

Disability claims experience

Communication skills

Analytical problem solving

Multitasking and prioritization

Education

High School Diploma or GED

Bachelor's degree (preferred)

Tools

ERISA knowledge

Job description

Guardian Life is seeking experienced Appeals Case Managers to adjudicate Group Life and Disability claim appeals under ERISA. This role supports short-term/long-term disability and life waiver appeals, with remote/mobility aspects and occasional travel.

The ACM 2 uses plan language, medical and financial information, and professional guidance to render fair, accurate appeal determinations while maintaining high service standards.