Remote Appeals Case Manager II

Guardian Life; Juneau (AK); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation package

Excellent medical, dental, vision and

Life and disability insurance

401(k) with company match

Tuition assistance & parental leave

Flexible time off

Job summary

Guardian Life is seeking Appeals Case Manager II to adjudicate assigned Group Life and Disability appeals under ERISA, evaluating claim files and applying plan provisions in accordance with regulations. The role supports Group Short-Term Disability, Long-Term Disability andLife Waiver of Premium appeals, requiring strong judgment and independent prioritization.

Remote position with potential travel, offering a competitive compensation package and benefits.

Qualifications

• 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, implement and execute investigation of disputed claims to ensure timely and compliant appeal resolution.
• Identify and interpret relevant plan language and thoroughly investigate all claim issues for non-biased appeal determinations.
• Evaluate medical, financial and other information with clinical/vocational input to resolve disputes.
• Provide proactive outreach and exceptional customer service to internal and external customers.
• Identify regulatory/compliance scenarios requiring additional research and facilitate resolution.
• Maintain up-to-date knowledge of ERISA and Department of Labor guidelines.
• Independently prioritize workload based on deadlines.
• Share insights with claims colleagues.

Skills

Group Disability experience

Communication skills

Analytical skills

Regulatory compliance

Multitasking

Education

High School Diploma or GED

Bachelor's degree or equivalent

Job description

Guardian Life is seeking Appeals Case Manager II to adjudicate assigned Group Life and Disability appeals under ERISA, evaluating claim files and applying plan provisions in accordance with regulations. The role supports Group Short-Term Disability, Long-Term Disability andLife Waiver of Premium appeals, requiring strong judgment and independent prioritization.

Remote position with potential travel, offering a competitive compensation package and benefits.