Appeals Case Manager II

Fully Remote

Remote
- United States

Full time

R

Guardian is seeking individuals with Group Disability claims experience to join our dynamic Appeals Team. The Appeals Case Manager II (ACM
2) is responsible for adjudicating assigned appeals for Group Life and Disability claims. The ACM 2 provides a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations.

This role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

A highly motivated and reliable individual who is able to work with varying levels of supervision – independently or collaboratively. You are detail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude.

• 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.

• Minimum of 3 years of experience handling appeals and/or complex claims.
• Bachelor's degree or equivalent combination of education and professional experience.

• 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.

As our Appeals Case Manager 2, you will report to our Leader
- Appeals Team, who reports to our Leader – Group Claims Appeals & Compliance.

This is a mobile position where preference may be given to candidates within commuting proximity to a Guardian office with the ability to travel to Guardian offices as determined by the People Leader.

Occasional 0-10% of the time.

• Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards

• Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.
• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups…