Remote Appeals Case Manager II: Disability & Life Claims

Guardian Life; Augusta (ME); Remote; USD 62,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation

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 individuals with Group Disability claims experience to join the Appeals Team as ACM 2. You will adjudicate appeals for Group Life and Disability claims, providing a full and fair reconsideration review under ERISA.

The role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, requiring independent prioritization and collaboration with clinical/vocational professionals to resolve disputes.

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

• 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.
• Provide proactive outreach to deliver 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 ERISA and Department of Labor guidelines.
• Independently prioritize workload based on deadlines.
• Share insights and learnings with claims colleagues.

Skills

Claims experience

Client focus

Communication skills

Analytical skills

Multi-tasking

Education

High School Diploma/GED

Bachelor's degree (preferred)

Job description

Guardian Life is seeking individuals with Group Disability claims experience to join the Appeals Team as ACM 2. You will adjudicate appeals for Group Life and Disability claims, providing a full and fair reconsideration review under ERISA.

The role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, requiring independent prioritization and collaboration with clinical/vocational professionals to resolve disputes.