Remote Appeals Case Manager II - Disability & Life Claims

Guardian Life; Providence (RI); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation

Excellent benefits

401(k) match

Tuition assistance

Parental leave

Flexible work options

Job summary

Guardian Life is seeking an Appeals Case Manager II to adjudicate Group Life and Disability appeals. You will conduct full, fair reconsiderations under ERISA, assess claim files, interpret plan language, and collaborate with clinical professionals to resolve disputes.

The role supports Short-Term Disability, Long-Term Disability, and Life Waiver of Premium appeals with travel as needed and a focus on regulatory compliance.

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.
• Preferred: Bachelor's degree or equivalent combination of education and professional experience.
• Experience handling appeals and/or complex claims is a plus.

Responsibilities

• Utilize claim management skills to plan, implement and execute investigation of disputed claims and ensure timely resolution.
• Identify and interpret plan language and thoroughly investigate claim issues for accurate appeal determinations.
• Evaluate medical, financial and other information with clinical/vocational input to resolve disputes.
• Provide proactive outreach to deliver superior customer service to internal and external customers.
• Identify legal/compliance scenarios requiring additional research and facilitate resolution.
• Maintain knowledge of ERISA and Department of Labor guidelines and regulatory changes.
• Prioritize workload independently to meet deadlines and share insights with colleagues.

Skills

Disability claims experience

Group life claims

Analytical skills

Communication skills

Multitasking

Regulatory compliance

Education

Bachelor's degree or equivalent

Job description

Guardian Life is seeking an Appeals Case Manager II to adjudicate Group Life and Disability appeals. You will conduct full, fair reconsiderations under ERISA, assess claim files, interpret plan language, and collaborate with clinical professionals to resolve disputes.

The role supports Short-Term Disability, Long-Term Disability, and Life Waiver of Premium appeals with travel as needed and a focus on regulatory compliance.