Appeals Case Manager II

This is a fully remote position, open to applicants in United States.

📋 Description

• Evaluate and decide on assigned appeals related to Group Life and Disability claims.

• Conduct thorough reconsideration reviews as mandated by ERISA.

• Review claim documentation and apply plan provisions in line with state and federal laws.

• Assist with appeals for Group Short-Term Disability, Long-Term Disability, and Life Waiver of Premium.

• Plan, implement, and carry out investigations for contested claims.

• Guarantee timely and compliant resolutions for appeals.

• Identify and interpret applicable plan language while investigating claim-related issues.

• Assess medical, financial, and additional claim information in collaboration with clinical and vocational experts.

• Offer proactive outreach and customer service to both internal and external stakeholders.

• Recognize legal and compliance situations that necessitate further research and facilitate their resolution.

• Stay updated on ERISA and Department of Labor regulations.

• Organize workload according to deadlines.

• Share insights and knowledge with colleagues in the claims department.

• Report directly to the Leader of the Appeals Team.

⛳️ Requirements

• A High School Diploma or GED is required.

• At least 5 years of experience in Group Disability and/or Life Claims is necessary.

• Strong client focus paired with exceptional verbal and written communication skills.

• Proven problem-solving, analytical, mathematical, and research abilities.

• Capability to handle multiple priorities and tasks while ensuring compliance with relevant regulations.

• Flexibility and adaptability in response to evolving business requirements.

• Preferably, a minimum of 3 years of experience managing appeals and/or complex claims.

• A Bachelor's degree or an equivalent combination of education and professional experience is preferred.

• Must be legally authorized to work in the United States without the need for current or future employer sponsorship.

• Willingness to travel to Guardian offices as required by the People Leader.

🏝️ Benefits

• Competitive compensation package.

• Medical, dental, supplemental health, life, and vision coverage for you and your dependents with no waiting period.

• Life and disability insurance.

• 401(k) plan with company match.

• Tuition assistance.

• Paid parental leave.

• Backup family care services.

• Opportunities for skill-building and leadership development.

• Philanthropic opportunities.

• Flexible time off.

• Flexible dress code.

• Policies for flexible work locations.

• Employee Resource Groups.

• Opportunities for social responsibility and volunteering.

• Educational partnerships with colleges.

• Initiatives focused on sustainability.