Appeals Case Manager II

Overview

Appeals Case Manager II adjudicates assigned appeals for Group Life and Disability claims, providing a full and fair ERISA reconsideration review of Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals.

What you'll do

• 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.

What you'll need

• High School Diploma or GED.
• 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.

Nice to have

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

Details

• Location: Remote - United States; mobile position where preference may be given to candidates within commuting proximity to a Guardian office.
• Travel: Occasional, 0-10% of the time.
• Reports to the Leader - Appeals Team.
• Legally authorized to work in the United States without employer sponsorship; no visa sponsorship offered.