Appeals Case Manager II at The Guardian Life Insurance Company of America

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Role Description

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.

• 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
• Independently prioritize workload based on individual and departmental deadlines
• Readily share insights and learnings with claims colleagues

Qualifications

• 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

Requirements

• Reporting Relationships: As our Appeals Case Manager II, you will report to our Leader, Appeals Team, who reports to our Leader, Group Claims Appeals & Compliance
• Location and Work Arrangement: Remote/Flexible – work primarily from home
• May be expected to come into a Guardian work location occasionally, as determined by your people leader
• Preference for candidates in close proximity to a Guardian hub office (Bethlehem, PA or Holmdel, NJ)
• Will consider applicants in other U.S. locations
• Travel Occasional (less than 10% of the time)
• Salary Range: $57,330.00 - $94,185.00
• The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate
• In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation

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