Remote Appeals Case Manager II – Disability Claims

Guardian Life; Austin (TX); Remote; USD 75,000 - 110,000; Full time

Benefits offered by this job

Life and disability insurance

A great 401(k) with company match

Tuition assistance paid parental leave

Job summary

Guardian Life is seeking an Appeals Case Manager II to adjudicate integrated Group Life and Disability appeals under ERISA. This fully remote, full-time role focuses on thorough reviewing of claims, applying plan provisions and ensuring fair reconsideration in accordance with federal and state regulations.

You will manage complex appeals, interpret plan language, collaborate with clinical and vocational professionals, and maintain knowledge of ERISA and DOL guidelines while delivering proactive

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 while ensuring regulatory compliance.
• Flexibility to adapt to changing business needs.

Responsibilities

• Plan, implement and execute the investigation of disputed claims to resolve appeals.
• Identify and interpret plan language and investigate claim issues for accurate determinations.
• Evaluate medical, financial and other information with clinical/vocational input for resolution.
• Provide proactive outreach and high level customer service to internal and external customers.
• Identify regulatory scenarios requiring additional research and facilitate resolution.
• Maintain knowledge of ERISA and Department of Labor guidelines and meet deadlines.

Skills

Group disability claims

Client-focused

Verbal & written communication

Analytical problem-solving

Regulatory compliance

Multi-tasking

Education

Bachelor's degree or equivalent

High School Diploma or GED

Job description

Guardian Life is seeking an Appeals Case Manager II to adjudicate integrated Group Life and Disability appeals under ERISA. This fully remote, full-time role focuses on thorough reviewing of claims, applying plan provisions and ensuring fair reconsideration in accordance with federal and state regulations.

You will manage complex appeals, interpret plan language, collaborate with clinical and vocational professionals, and maintain knowledge of ERISA and DOL guidelines while delivering proactive