Remote Appeals Case Manager II – Disability & Life

Guardian Life; Olympia (WA); 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 and parental leave

Flexible work location policies

Job summary

Guardian Life is seeking an Appeals Case Manager II with Group Disability claims experience to adjudicate appeals for Life and Disability benefits. This mobile, remote role supports Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals and operates under ERISA guidelines.

You are a motivated, reliable professional who can work independently or with supervision, managing multiple priorities with attention to detail and sound judgment.

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 claims

Life claims experience

Client focus

Analytical skills

Regulatory compliance

Flexibility/adaptability

Education

High School Diploma or GED

Bachelor's degree or equivalent

Job description

Guardian Life is seeking an Appeals Case Manager II with Group Disability claims experience to adjudicate appeals for Life and Disability benefits. This mobile, remote role supports Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals and operates under ERISA guidelines.

You are a motivated, reliable professional who can work independently or with supervision, managing multiple priorities with attention to detail and sound judgment.