Remote Appeals Case Manager II – Disability Claims

Guardian Life; Richmond (VA); Remote; USD 59,000 - 96,000; Full time

Job summary

Guardian Life is seeking an Appeals Case Manager II with extensive Group Disability and Life claims experience to adjudicate assigned appeals under ERISA. The role involves thorough review of claim files, applying plan provisions and ensuring compliant, fair reconsiderations.

You will analyze medical, financial, and other information, coordinate with clinical professionals, and maintain up-to-date knowledge of ERISA and DOL guidelines while delivering high-quality customer service.

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

• Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution.
• Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination.
• Evaluate medical, financial and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.
• Utilize proactive outreach to provide superior customer service to all internal and external customers.
• Identify legal and/or compliance scenarios that require additional research; facilitate resolution.
• Maintain current knowledge of all ERISA and Department of Labor guidelines.
• Independently prioritize workload based on individual and departmental deadlines.
• Readily share insights and learnings with claims colleagues.

Skills

Group disability

Life claims

Client focus

Communication

Regulatory compliance

Education

Bachelor's degree

Job description

Guardian Life is seeking an Appeals Case Manager II with extensive Group Disability and Life claims experience to adjudicate assigned appeals under ERISA. The role involves thorough review of claim files, applying plan provisions and ensuring compliant, fair reconsiderations.

You will analyze medical, financial, and other information, coordinate with clinical professionals, and maintain up-to-date knowledge of ERISA and DOL guidelines while delivering high-quality customer service.