Senior Remote Appeals Case Manager

Guardian Life; Honolulu (HI); Remote; USD 59,000 - 96,000; Full time

Benefits offered by this job

Competitive compensation

Excellent medical, dental, vision & 1‑

401(k) with company match

Job summary

Guardian Life seeks an Appeals Case Manager II (ACM 2) to adjudicate appeals for Group Life and Disability claims, performing a full and fair reconsideration under ERISA. The role handles Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, with remote work in the United States.

You will manage investigations, interpret plan language, coordinate with clinical staff, and ensure timely, compliant resolutions while maintaining knowledge of ERISA guidelines and

Qualifications

• 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 regulatory compliance.
• Flexibility and adaptability to changing business needs.

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

Verbal communication

Written communication

Attention to detail

Analytical thinking

Time management

Education

High School Diploma or GED

Bachelor's degree (preferred)

Job description

Guardian Life seeks an Appeals Case Manager II (ACM 2) to adjudicate appeals for Group Life and Disability claims, performing a full and fair reconsideration under ERISA. The role handles Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals, with remote work in the United States.

You will manage investigations, interpret plan language, coordinate with clinical staff, and ensure timely, compliant resolutions while maintaining knowledge of ERISA guidelines and