Remote ERISA Appeals Case Manager II

Guardian Life; Carson City (NV); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive pay

Excellent health benefits

Life and disability insurance

401(k) match

Tuition assistance

Parental leave

Flexible work policy

ERGs

Community involvement

Job summary

Guardian seeks individuals with Group Disability claims experience to join the Appeals Team as an Appeals Case Manager II (ACM 2). The role adjudicates assigned appeals for Group Life and Disability claims under ERISA, providing a full and fair reconsideration review.

This mobile position supports remote work with occasional travel to Guardian offices as determined by leadership. You will analyze files, interpret plan language, and collaborate with clinical and vocational professionals to

Qualifications

• 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.
• 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

Strong communication

Problem solving

Analytical skills

Prioritization

Regulatory compliance

Education

High School Diploma or GED

Bachelor's degree or equivalent

Job description

Guardian seeks individuals with Group Disability claims experience to join the Appeals Team as an Appeals Case Manager II (ACM 2). The role adjudicates assigned appeals for Group Life and Disability claims under ERISA, providing a full and fair reconsideration review.

This mobile position supports remote work with occasional travel to Guardian offices as determined by leadership. You will analyze files, interpret plan language, and collaborate with clinical and vocational professionals to