Senior Appeals Case Manager - Disability & Life

The Guardian Life Insurance Company of America; United States; Hybrid; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation package

Excellent health coverage

401(k) with company match

Tuition assistance and parental leave

Flexible time off

Job summary

The Guardian Life Insurance Company of America is seeking an Appeals Case Manager II with group disability experience to adjudicate appeals for life and disability claims. This mobile role involves evaluating plan language, coordinating with clinical professionals, and ensuring timely, compliant resolutions under ERISA guidelines.

Reporting to the Leader - Appeals Team, you will manage multiple priorities, provide excellent customer service, and stay current with regulatory requirements while

Qualifications

• Minimum of 5 years of Group Disability and/or Life Claims experience.
• Strong client focus with excellent verbal and written communication skills.
• Ability to manage multiple priorities while complying with regulatory requirements.

Responsibilities

• Plan, implement and execute the investigation of disputed claims and ensure timely, compliant appeal resolution.
• Identify and interpret relevant plan language and investigate all claim issues to make an accurate appeal determination.
• Evaluate medical, financial and other information with clinical/vocational input as needed.
• Provide proactive outreach to deliver excellent customer service to internal and external customers.
• Identify legal/compliance scenarios requiring additional research and facilitate resolution.
• Maintain current knowledge of ERISA and Department of Labor guidelines.
• Prioritize workload independently based on deadlines and team needs.
• Share insights with claims colleagues to improve processes.

Skills

Group disability/life claims

Verbal and written communication

Problem solving and analytical skills

Regulatory compliance knowledge

Multitasking and prioritization

Adaptability and flexibility

Education

High School Diploma or GED

Bachelor’s degree or equivalent experience

Job description

The Guardian Life Insurance Company of America is seeking an Appeals Case Manager II with group disability experience to adjudicate appeals for life and disability claims. This mobile role involves evaluating plan language, coordinating with clinical professionals, and ensuring timely, compliant resolutions under ERISA guidelines.

Reporting to the Leader - Appeals Team, you will manage multiple priorities, provide excellent customer service, and stay current with regulatory requirements while