Senior Appeals Specialist – Disability & Life (Remote)

Guardian Life; Bismarck (ND); À distance; USD 59 000 - 96 000; Plein temps

Avantages offerts par ce poste

Competitive compensation

Excellent health coverage (medical, d.

401(k) with company match

Tuition assistance

Parental leave

Remote-friendly environment

Résumé du poste

Guardian Life is seeking an Appeals Case Manager II (ACM 2) to adjudicate appeals for Group Life and Disability claims on the Appeals Team. This fully remote role handles ERISA-based reconsiderations, supporting short-term disability, long-term disability, and life waiver of premium appeals.

You will prioritize multiple tasks, interpret plan language, and coordinate with clinical professionals to resolve disputes, while maintaining current ERISA knowledge and delivering excellent customer

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.

Responsabilités

• 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.

Connaissances

Group disability claims experience

Strong client focus

Communication skills

Problem solving

Regulatory compliance

Adaptability

Formation

High School Diploma or GED

Bachelor's degree or equivalent

Description du poste

Guardian Life is seeking an Appeals Case Manager II (ACM 2) to adjudicate appeals for Group Life and Disability claims on the Appeals Team. This fully remote role handles ERISA-based reconsiderations, supporting short-term disability, long-term disability, and life waiver of premium appeals.

You will prioritize multiple tasks, interpret plan language, and coordinate with clinical professionals to resolve disputes, while maintaining current ERISA knowledge and delivering excellent customer