Senior Appeals Case Manager – Disability & Life Claims

Guardian Life; Northern (KY); Hybrid; USD 59,000 - 96,000; Full time

Benefits offered by this job

Medical and dental coverage

Vision coverage

Life and disability insurance

401(k) with company match

Tuition assistance

Parental leave

Flexible time off

Job summary

Guardian Life is seeking an Appeals Case Manager II with group disability claims experience to adjudicate and reconsider appeals for group life and disability benefits under ERISA. The role supports short- and long-term disability and life waiver of premium appeals, working independently or with supervision as needed.

The ideal candidate will have strong analytical skills, excellent communication, and the ability to manage multiple priorities while ensuring 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.
• Ability to manage multiple priorities while ensuring regulatory compliance.
• Preferred: 3+ years handling appeals and/or complex claims.

Responsibilities

• Utilize effective claim management skills to 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

Disability claims

Claims adjudication

ERISA knowledge

Communication skills

Analytical skills

Education

High School Diploma or GED

Bachelor's degree (preferred)

Job description

Guardian Life is seeking an Appeals Case Manager II with group disability claims experience to adjudicate and reconsider appeals for group life and disability benefits under ERISA. The role supports short- and long-term disability and life waiver of premium appeals, working independently or with supervision as needed.

The ideal candidate will have strong analytical skills, excellent communication, and the ability to manage multiple priorities while ensuring regulatory compliance.