Appeals Case Manager Ii

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 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.

You have

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

You will

• Independently prioritize workload based on individual and departmental deadlines.
• Readily share insights and learnings with claims colleagues.
• Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination.
• Identify legal and/or compliance scenarios that require additional research; facilitate resolution.
• Utilize proactive outreach to provide superior customer service to all internal and external customers.
• Maintain current knowledge of all ERISA and Department of Labor guidelines.
• Evaluate medical, financial, and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes.
• Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution.

Reporting Relationships

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

Location /Travel

Work from home flexibility. May be expected to come into a Guardian office location as determined by their People Leader.

Salary Range

$55,100.00 - $90,530.00

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

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

Life and Disability Insurance

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

Retirement and Financial

• Complimentary 1:1 financial guidance with a licensed Fidelity representative
• 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

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

Emotional Well-being and Work-Life

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

Justice, Equity, Diversity & Inclusion (J.E.D.I.)

• Matching gifts/volunteering
• J.E.D.I. certification and training programs
• Employee Resource Groups that advocate for inclusion and diversity

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.

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected].