Remote Appeals Case Manager II – Disability & Life Claims

Guardian Life; Boise (ID); À distance; USD 59 000 - 96 000; Plein temps

Avantages offerts par ce poste

Health insurance

401(k) with company match

Tuition assistance

Parental leave

Résumé du poste

Guardian Life is seeking an Appeals Case Manager II to adjudicate group life and disability appeals on the ACM 2 team. This role provides a full and fair reconsideration review under ERISA by thoroughly assessing the claim file and applying plan provisions in line with state and federal regulations, supporting Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

You are a motivated, detail‑oriented professional who can work independently or with supervision.

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.

Responsabilités

• Plan, implement and investigate disputed claims; ensure timely and compliant appeal resolution.
• Identify and interpret relevant plan language; conduct thorough investigations.
• Evaluate medical, financial and other information with clinical/vocational input for dispute resolution.
• Provide proactive outreach to deliver superior customer service to internal and external customers.
• Identify legal/compliance scenarios needing additional research; facilitate resolution.
• Maintain knowledge of ERISA and DOL guidelines.
• Independently prioritize workload to meet deadlines.
• Share insights with claims colleagues.

Connaissances

Group Disability/Life claims

Client focus

Analytical/problem solving

Attention to detail

Multitasking/prioritization

Regulatory/compliance knowledge

Formation

High School Diploma or GED

Bachelor's degree

Description du poste

Guardian Life is seeking an Appeals Case Manager II to adjudicate group life and disability appeals on the ACM 2 team. This role provides a full and fair reconsideration review under ERISA by thoroughly assessing the claim file and applying plan provisions in line with state and federal regulations, supporting Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

You are a motivated, detail‑oriented professional who can work independently or with supervision.