Appeals Case Manager II

Skills :     Account Manager

Job 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. 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.

You are

A highly motivated and reliable individual who can work with varying levels of supervision, independently or collaboratively. You are a detailed decision-maker able to manage several priorities at the same time with a positive attitude.

You have

• High School Diploma or GED required.
• 5+ years of Group Disability and/or Life claims experience.
• 3+ years of experience handling appeals or complex claims (preferred).
• Demonstrated verbal and written communication skills.
• Problem-solving, analytical, math proficiency, and information research skills.
• Proven ability to manage multiple tasks in accordance with regulatory requirements.

You will

• 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.
• Use proactive outreach to provide outstanding 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.

Location/Travel

Salary Range

$56,200.00 - $92,335.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. 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.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. 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.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

• Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender-inclusive benefits
• Dental plan
• Vision plan
• Health care accounts – flexible spending, health reimbursement, and health savings accounts

Life and Disability Insurance

• Company-paid Life and Disability insurance plus voluntary supplemental coverage

Retirement and Financial

• 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

Time Off and Remote Work

• Flexible work arrangements (part in-person/part remote)
• Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement
• Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

Emotional Well-being and Work-Life

• Emotional well-being, mental health, and work/life resources powered by Spring Health
• Wellness programs, including fitness programs and equipment reimbursement
• Child, adult, and elder back-up care support through Bright Horizons
• Adoption assistance
• College planning
• Tuition reimbursement
• Student loan assistance

Equity & Inclusion

Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:

• Employee Resource Groups:
• Colleague Connection Committees

A culture that encourages colleagues to bring their authentic selves to work

• Voluntary self-ID

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.

Equal Employment Opportunity

Guardian is an equal-opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or receive other benefits and privileges of employment, please contact [email protected].