Remote Appeals Case Manager II - Disability & Life Claims

Guardian Life; Frankfort (KY); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Medical & dental coverage

Life & disability insurance

401(k) with company match

Tuition assistance

Parental leave

Flexible time off

Job summary

Guardian Life is seeking individuals with Group Disability claims experience to join our Appeals Team as an Appeals Case Manager II. The ACM 2 adjudicates appeals for Group Life and Disability claims under ERISA, reviewing files and applying plan provisions in line with state and federal regulations.

This mobile role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

Qualifications

• 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 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.

Skills

Group Disability

Life Claims

Analytical skills

Communication skills

Regulatory knowledge

Education

Bachelor's degree

High School Diploma or GED

Job description

Guardian Life is seeking individuals with Group Disability claims experience to join our Appeals Team as an Appeals Case Manager II. The ACM 2 adjudicates appeals for Group Life and Disability claims under ERISA, reviewing files and applying plan provisions in line with state and federal regulations.

This mobile role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.