Absence Claims Case Manager I

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $41.9k - $62.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Guardian Life

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1860

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

💰 Non Equity Assistance on 2016-08

Healthcare • Consulting • Food & Beverage

Guardian Life is a comprehensive insurance provider offering a wide range of insurance products and services. Founded 160 years ago, the company has grown to serve over 12 million people daily. Guardian Life specializes in various insurance plans, including life, disability, dental, vision, accident, critical illness, and hospital indemnity insurance. The company also provides workforce solutions such as group benefits, absence management, paid leave, and benefits technology. Furthermore, Guardian Life offers investment services, annuities, and retirement plans, supported by financial professionals. The firm is committed to social responsibility, equity, and inclusion, partnering with organizations to foster well-being and financial health. With a strong network and deep industry experience, Guardian Life continues to be a reliable partner in protecting individuals and families while preparing them for the future.

📋 Description

• Adjudicate and medically manage Short Term Disability and absence claims • Administer claims alongside FMLA, State Paid Medical Leave, and State Paid Disability • Interpret contract provisions, plan design, medical information, and regulatory requirements • Communicate claim status and decisions by telephone and in writing • Contact claimants, physicians, employers, and planholders to gather information and assess job accommodations • Identify claim issues and develop, execute, and adjust action plans • Determine coverage, benefit eligibility, disability status, insured earnings, offsets, underpayments, and overpayments • Review occupational requirements, medical documentation, payroll information, and income sources • Review and validate AI-generated claim recommendations, data extractions, draft correspondence, and flagged discrepancies • Establish and document claim action plans, including return to the claimant’s own job • Use Medical Disability Guidelines and other disability tools to assess claim duration • Facilitate return-to-work and job-accommodation opportunities • Recover overpayments or negotiate installment arrangements • Assess restrictions and limitations and establish appropriate partnership with PRT • Meet turnaround-time, quality-assurance, customer-experience, compliance, and audit-readiness deliverables • Report to the Team Leader, STD/Absence

🎯 Requirements

• Bachelor’s degree preferred; not stated as required • Strong math aptitude, including calculating benefits and reviewing payroll or income information • Critical thinking, problem-solving, analytical reasoning, sound judgment, and decision-making skills • Ability to interpret medical information, contract language, plan provisions, and regulatory requirements • Ability to prioritize and multitask across multiple business applications • Ability to work independently within established procedures and in a collaborative team environment • Clear and professional verbal and written communication skills • Ability to manage multiple priorities and meet departmental turnaround times • Resilience and adaptability in a high-volume, fast-paced claims environment • Strong customer-service skills • Proficiency with Microsoft Windows applications, including Microsoft Word, Excel, and Outlook • AI/Copilot prompting skills preferred • Ability to review and validate AI-generated recommendations, extractions, and correspondence • Data-quality assurance and attention to detail, including completeness, accuracy, compliance, and audit-readiness of claim files • Successful completion of a job-related assessment required • Group Benefits experience preferred, including Short Term Disability, Statutory Paid Leave, Family Medical Leave, adjacent insurance industry, regulatory and compliance, or equivalent professional experience • Legally authorized to work in the United States without current or future employer sponsorship

🏖️ Benefits

• Full-time eligible employees receive company benefits and resources • Skill-building opportunities • Leadership development opportunities • Philanthropic opportunities • Contemporary, supportive, flexible, and inclusive benefits and resources • Reasonable accommodation for qualified individuals with disabilities • Remote work arrangement • Potential eligibility for annual, sales, or other incentive compensation