Remote Appeals Case Manager II - Disability & Life

Guardian Life; Jackson (MS); Remote; USD 59,000 - 96,000; Full time

Job summary

Guardian Life seeks an Appeals Case Manager II with group disability and life claims experience to adjudicate appeals under ERISA. This mobile role supports short- and long-term disability and life waiver of premium appeals, ensuring fair reconsideration and compliant resolutions.

You will review files, interpret plan language, and collaborate with clinical professionals to resolve disputes while delivering excellent service to internal and external customers.

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 regulatory compliance.
• Flexibility and adaptability in response to changing business needs.
• Minimum of 3 years of experience handling appeals and/or complex claims.
• Bachelor's degree or equivalent combination of education and professional experience.

Responsibilities

• 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 claims experience

Life Claims experience

Client focus

Verbal communication

Written communication

Analytical skills

Multi-tasking

Education

High School Diploma or GED

Bachelor's degree (Preferred)

Job description

Guardian Life seeks an Appeals Case Manager II with group disability and life claims experience to adjudicate appeals under ERISA. This mobile role supports short- and long-term disability and life waiver of premium appeals, ensuring fair reconsideration and compliant resolutions.

You will review files, interpret plan language, and collaborate with clinical professionals to resolve disputes while delivering excellent service to internal and external customers.