Appeals Case Manager II - Remote

Overview

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.

In Short

• Provide a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA)
• Thoroughly assess the claim file and apply plan provisions in accordance with applicable state and federal regulations
• Support Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals
• 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

Requirements

• A minimum of 5 years of Group Disability and/or Life claims experience
• A minimum of 3 years of experience handling appeals or complex claims (preferred)
• Bachelor’s Degree (preferred) or equivalent professional experience
• A client focus with excellent verbal and written communication skills
• Strong problem-solving, analytical, math aptitude and information research skills
• Demonstrated ability to manage multiple tasks in accordance with regulatory requirements
• The ability to remain flexible due to changing business needs

Benefits

• Support and flexibility to achieve your professional and personal goals
• Skill-building, leadership development and philanthropic opportunities
• Contemporary, supportive, flexible, and inclusive benefits and resources