Remote Appeals Case Manager II - Group Claims

Guardian Life; Salem (OR); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Excellent health coverage

401(k) with company match

Tuition assistance

Flexible time off

Social responsibility initiatives

Job summary

Guardian Life is seeking individuals with Group Disability claims experience to join our Appeals Team as ACM 2. You will adjudicate assigned appeals for Group Life and Disability claims under ERISA, reviewing files and applying plan provisions in accordance with applicable state and federal regulations.

This remote role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals while you manage multiple priorities and maintain 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 while ensuring regulatory compliance.
• Flexibility and adaptability in response to changing business needs.
• Bachelor's degree or equivalent combination of education and professional experience.

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.
• 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

Communication skills

Problem-solving

Analytical thinking

Regulatory compliance

Adaptability

Education

Bachelor's degree or equivalent

Job description

Guardian Life is seeking individuals with Group Disability claims experience to join our Appeals Team as ACM 2. You will adjudicate assigned appeals for Group Life and Disability claims under ERISA, reviewing files and applying plan provisions in accordance with applicable state and federal regulations.

This remote role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals while you manage multiple priorities and maintain regulatory compliance.